t*$m 



*>**»* 



THE 



FEMALE INSTRUCTOR 



AND 



GUIDE TO HEALTH. 



BY 



/ 

G. W. SIMPSON, A. M., M. D., 

GRADUATE OF THE ECLECTIC UNIVERSITY OF PENNSYLVANIA ; ALSO OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS OF BALTIMORE, MD. ; 

ALSO A MEMBER OF THE NATIONAL MEDICAL ASSOCIATION OF 

NORTH AMERICA AND OF OTHER SIMILAR ASSOCIATIONS. 



BALTIMORE: 

1875. 




filtered according to act of Congress, in the year 1874, by 

G. W. SIMPSON, A. M., M. P., 

In the office of the Librarian of Congress, at Washington, I\ 0. 



Printed by DEUTSCH & CO.. Baltimore, Md 



TO 



FEMALE SOCIETY GENERALLY 



IS THIS VOLUME 



RESPECTFULLY DEDICATED, 



HOPING 



IT MAY. PROVE A BLESSING 



TO ALL 



WHO MAY PERUSE ITS PAGES. 



THE AUTHOR- 



PREFACE. 



To the reader of this volume I would say, that 
it has "been prepared at the cost of no little time 
and trouble as well as pecuniary means. It gives me 
pleasure, however, now to he able to present it to 
my many friends for their patronage, hoping it will 
prove to be what it is called: "The Female Instruc- 
tor and Guide to Health/ ' 

Two principal considerations have induced me to 
prepare this work. First, frequent and earnest so- 
licitations, of friends to do so ; secondly, the great 
need of such a book for female instruction and gui- 
dance. The latter reason, however, has had greater 
bearing on my mind than the former in influencing 
me to undertake the task. 

My practice for a few years past has been largely 
composed of the female portion of society. In fact, 
I have made obstetrics and diseases of women and 
children a specialty since my first graduation. I 
have had, therefore, a good chance to observe the 
great ignorance of women generally upon subjects 
that so intimately concern them, as do those con- 



VI PREFACE. 

tained in this book ; subjects upon the proper know- 
ledge of which depends to a large extent, the health 
and happiness of every female. The number of wo- 
men who seem to have attained even a respectable 
knowledge of their physical nature, the laws of 
health and the diseases peculiar to the female sex, 
is comparatively small. It is true that women gen- 
erally know that certain things are natural to occur 
with them, that can not take place with the opposite 
sex, but from what cause, how and for what pur- 
pose, they are not able to tell us. 

In order to illustrate what has been said, let us 
mention the function of menstruation. Now this 
function is peculiar to the human female and one of 
the very first importance, having, as it does, de- 
pendent upon its healthful performance, the health 
of the female economy. Yet it is astonishing to see 
how uninformed women are upon the subject. It is 
true every woman is aware that at a certain period 
in her life a change takes place, which is commonly 
called the change of life, &c. ; that every twenty- 
eight days, there is a discharge of blood ; that this 
flow continues to recur for a certain number of years, 
or until a certain period in life, when it ceases to 
appear. But as to the real nature of menstruation, 
what is its cause, from whence it emanates, &c 7 
but few are able to say. 

Again, take, if you please, impregnation and 
conception. It is the general impression that these 



PREFACE VIE 

imply the same thing. It is not understood that 
they are separate and distinct works of nature; the 
former being the union and commingling of the 
germ-cell egg, or ovum of the female and the sperm- 
cell of the male ; the latter the fixation of the im- 
pregnated or fecundated ovum to the walls of the 
womb. 

Moreover, if we speak of gestation, but few are 
able to comprehend its meaning. It is little dreamed 
of, that it implies the development and growth of ' 
the impregnated ovum after its fixation to the ute- 
rine walls, until the full term is accomplished and 
the new being is ready to be born into the world. 

Furthermore, parturition or labor is a process, 
the nature and mechanism of which, women know 
but little about. It is true, every woman, married 
and single, knows full well, that in order to con- 
summate the process of parturition, it is necessary 
for the patient to have more or less pain, but as to 
some of the most important questions that could pos- 
sibly engage the attention of women, relative to the 
subject, they are utterly unacquainted with them: viz. 
what causes those pains ? How does the womb expel 
its contents, by muscular contraction ? What is the 
normal position of the child at this time ? of how 
many stages does labor consist, of three^ if so, when 
do they severally begin and when do they end, &c. 

But see how greatly in ignorance women are 'in 
regard to disease in its various forms that prevails 



VIII PREFACE. 

among them, causing so much sufferings premature 
decay and death ; also its nature, cause, symptoms, 
effects, &c. Two women in every three in the Uni- 
ted States suffer more or less from diseases peculiar 
to the female sex. I have known a great many, who 
supposed they had dyspepsia, liver disease, consump- 
tion, &c, when really no such disease existed. The 
symptoms that were regarded dyspeptic, were only 
sympathetic or caused by the reflex-action of some 
local irritation of the nerves of the womb. 

Now the question is, why is it that women are 
living so far beneath their privilege, as it regards a 
more extended acquaintance with themselves ? 

In the first place, they are greatly in fault them- 
selves. The female portion of society do not read 
as much on those subjects as is their privilege and 
duty to do. Too many women spend their time in 
reading the fictitious literature that is flooding the 
country, in the way of hundreds of books, of nov- 
els and weekly papers. This fictitious literature is 
eagerly sought for by every class of society, but es- 
pecially by the female portion. They seem to have 
a particular relish for it, and there is no doubt in 
my mind, that many times every other interest is 
neglected in thus reading what they* suppose to be 
something, but in the end proves to be nothing. 
Nothing can be accomplished without effort, and 
women must put forth effort in order to attain to 
what is their duty to do, know themselves. 



PREFACE. L\ 

In the second place, physicians are much in fault 
in this respect. True, there may have been no di- 
rect effort on our part to keep the people in igno- 
rance, but we have taken no special pains to in- 
struct and enlighten them. As for one, I have no 
hesitation in acknowledging my remissness in this 
regard in the past, but I hope to make amends in 
the future. I conceive it to be the duty of every 
faithful physician not only to visit and prescribe for 
his patient, but to take some pains to explain the 
precise nature of the disease and the organ or part 
affected. The physician thus discharging his duty, 
not only confers a lasting blessing upon his patients, 
but at the same time secures to himself their abiding 
confidence and respect. 

I conceive ^t to be an indisputable fact, that a vast 
amount of female disease and suffering is attributed 
to their inexcusable ignorance of themselves ; of their 
peculiar functions, in the nature and healthful per- 
formance of which there is a beauty and grandeur 
inexpressible ; of the laws of health and how to ob- 
serve them. Were women indoctrinated in these 
things, their disease and suffering would be propor- 
tionally less. 

How can women place a proper estimate on them- 
selves, unless they understand their worth ? I con- 
tend that a person is incompetent to appreciate an 
object, no matter how valuable that object may be,, 
until they first know its value. 



X PBEEACE. 

To one who does not know how precious and costly 
an article a diamond is, it would seem like any other 
stone, except in shape and transparency ; but place 
it in the hands of one, who, has a previous know- 
ledge of the worth qfi a diamond, and he will at 
once properly estimate it. 

Again, we are not able to estimate the worth of 
an individual, without having fully ascertained who" 
he is ; but if after a close and continued acquaint- 
ance we find him to be a man of honesty, industry, 
sobriety, &c, we value him as a good citizen, ap- 
preciate his society and court his good-will. 

So it may be said of religion. One of the best rea- 
sons in the world why everybody does not become 
religious is because everybody does not seek to find 
out, and therefore does not understand the worth of 
religion. 

And so of everything else. Our appreciation is 
proportionate to our knowledge of an object. This 
seems to be a law implanted within our being, and 
we must obey it. 

And, returning to our subject, the same may be 
said of women ; in proportion to their attainments 
in the knowledge of themselves, will be their estima- 
tion, and upon this to a large extent will depend 
their health and happiness. 

THEE AUTHOE, 

Baltimore, 1875. 



COHSTTZEnsTTS. 



PART I. 

PAGE 

CHAPTER I.— The womb and its appendages 1 

CHAPTER II.— Menstruation 7 

CHAPTER III. — The commencement, continuation and ces- 
sation of menstruation 12 

CHAPTER IV.— Disorders of Menstruation 18 

CFTAPTER V. — Generation, conception and impregnation. 26 
CHAPTER VI.— Corpus Luteum of Menstruation and Cor- 
pus Luteum of pregnancy ..... 31 

CHAPTER VII.— Difference between impregnation and 

conception 38 

CHAPTER VIII.— Gestation 34 

CHAPTER IX. — Development of the new being 43 

CHAPTER X.— The placenta or after-birth; fetal circula- 
tion; aration of blood in the after-birth 49 

CHAPTER XL— Signs of pregnancy 54 

CHAPTER XII. — Duration of pregnancy and the viability 

of the child 61 

CHAPTER XIII.— Sterility C2 

CHAPTER XIV.— Spurious pregnancy , G4 

CHAPTER XV— Superfetation 60 

CHAPTER XVI.— Extra-uterine pregnancy 68 

CHAPTER XVII.— The influence of the mother upon the 

child 74 

CHAPTER XVIII.— Abortion 76 

CHAPTER XIX.— Prevention of pregnancy 80 



XK CONTENTS. 

PART II. 

PAGE. 

CHAPTER I.— Parturition or labor 84 

•CHAPTER II.— Some of the difficulties of confinement.... 113 

CHAPTER III.— Puerperal fever , 119 

CHAPTER IV.— Sudden death of the Mother after labor.. 122 

PAET III. 

DISEASES OF WOMEN. • 

CHAPTER L— Diseases of the breasts 125 

CHAPTER II. — Maternal Stomatitis or nursing sore mouth 133 

CHAPTER III.— Diseases of the labia, perineum and vulva 134 

CHAPTER IV. —Diseases of the vulva 138 

CHAPTER V.— Inflammation of the womb 143 

CHAPTER VI.— Ulceration of the womb 145 

CHAPTER VII.— Displacements of the womb ..... 147 

CHAPTER VIII.— Cancer of the womb 151 

CHAPTER IX. -Tumors of the womb 153 

CHAPTER X.— Ovarian Tumors 154 

CHAPTER XL— Diseases of women 156 

CHAPTER XII.— Leucorrhea 160 

CHAPTER XIII.— Chlorosis 163 

MISCELLANY. 

The effects of the Sewing Machine on the health and mor- 
als of Females 16G 

Moral and physical influence of the mother's mind on the 

embryo in utero 169 

Rules for School Girls and Misses 172 

Rules for Young Ladies 175 

Rules for Married Women 176 

A Key or explanation of words that are not used in every- 
day conversation 179 



PART I. 

— # 

CHAPTER I. 
THE WOMB AND ITS APPENDAGES. 

The womb, or uterus, as it is usually called by the various 
medical writers, is properly the organ of gestation. The of- 
fice it performs is the retention and support of the fecundated 
ovum during the development of the fetus, and the expulsion 
of the child at full term. The womb is an organ peculiar to 
the human female ; there is, however, an' approximation to 
such an organ in the mammalia. In the female who has never 
borne. children it is pear-shaped. It is the largest of the gen- 
erative organs. " 

It is situated between the rectum and bladder, being above 
the former and beneath the latter. It occupies the space be- 
tween these two organs. It is not perpendicular, but inclines 
a little forward, and its fundus, or broad upper part, rises some- 
what above the level of the bladder. The size of the womb is 
from two and a half to three inches in length, two inches in 
breadth at its upper part, about one inch in thickness and 
from one to two ounces and a half in weight. 

It has been divided, for the sake of convenience, into body, 
fundus and neck. These different parts are painted out in the 
annexed cut. The structure of the uterus consists of three 

1 



2 THE WOMB^ND ITS APPENDAGES. 

distinct coats ; the external coat is called serous, the middle 
muscular, the internal mucous. It is, however, composed most 
largely of the muscular coat, which is very firm and dense, 
and in the impregnated state it is fully developed and exhibits 
three layers. 




THE WOMB AND ITS APPENDAGES. 



3 



The os uteri, or mouth of the womb, varies in form ; in some 
persons it is a transverse slit ; in others a circular opening ; 
in some, triangular ; in others it looks very much like a leech 
bite and usually about the size of a goose quill. 

The canal of the cervix is from a half to three quarters of 
an inch in length ; leading from the mouth, it first widens y 
and as it continues it contracts, and where it enters the cavity 
of the womb it forms what is known as the os uteri internum 
or internal mouth 

THE APPENDAGES OF THE WOMB. 

THE VAGINA. 

This has not been classed as an appendage of the womb, by 
anatomists, but for the sake of convenience, we speak of it in 
this connection. Although it may not be considered as an ap- 
pendage in the same light as those generally mentioued as 
such, it is, however, an important womb attachment; for it is 
attached to the neck of the womb just above the os uteri, caus- 
ing a projection of the mouth of the womb a short distance in- 
to the vaginal canal. 

The vagina is a musculo-membranous canal, being in the 
centre of the pelvis and extending from the vulva through the 
cavity of the pelvis, and as has been remarked above, becomes 
'attached to the uterus a little above the os uteri and occupies 
a space between urethra and bladder above and the rectum be- 
neath, and is curved in its direction, corresponding with the 
curve of the sacrum. 

The form of the vagina is cylindrical and narrow with some 
constriction at its commencement, but near its uterine cavity 
it becomes dilated. 



4 THE WOMB AND ITS APPENDAGES. 

Its size varies according to age and circumstances ; its aver- 
age length along its anterior, is about four inches ; and five or 
six along its posterior wall. In females who have not borne 
children it is longer and narrower than in those who have. 

The vagina is an important organ in its use. It is for the 
transmission of the menses, for copulation, and for the trans- 
mission of the child at the time of labor. In health the inner 
membrane of the vagina secretes enough to lubricate the parts 
adjacent, but during labor the secretion is very profuse and 
is for the purpose of facilitating the birth of the child. 



THE FALLOPIAN TUBES. 

These are two cylindrical canals, about four inches in length, 
extending from the right and left superior angle of the womb ' 
to the ovaries ; each of these consists of a serous, muscular 
and mucous coat. Its canal is very small, scarcely large enough 
to admit a small bristle. Internally where they open into the 
womb, the canal is very narrow; it afterwards, however, ex- 
pands and contracts towards the external termination, where it 
opens into the abdomen. The tube widens near the ovary in- 
to a trumpet-shape extremity. Its ovarian orifice is sur- 
rounded by a fringe-like process, and one of these processes is 
connected with the ovary. The name of fimbriated extremity is 
given to this part of the tube, and it closes around and embra- 
ces the ovary during sexual excitement. 

The ofiice of the fallopian tube, is the transmission of the 
spermatozoa to the ovary, and then convey the impregnated 
ovum from the ovarian bed to the cavity of the uterus. 



THE WOMB AND ITS APPENDAGES. 



THE OVARIES. 



These organs are the essential ones to generation in the fe- 
male. They frequently become diseased, and sometimes they 
are absent; in either of which case sterility is a natural result. 
They are oval shaped, and very much resemble in structure 
the male testicles. Their situation is on each side of the womb, 
and connected thereto by its anterior margin with the broad 
ligament, by its inner extremity to the womb, by the. posterior 
duplicature of the broad ligament, termed the ligament of the 
ovary, and by its outer end to the fimbriated extremity of the 
fallopian tube by a short cord of a ligamentous nature. The 
size of each ovary is about an inch and a half in length, three- 
quarters of an inch in thickness, and about from one-eigth to 
one -fourth of an ounce in weight. They are smooth externally 
in virgins, but in old age assume a wrinkled appearance. 

Within the substance of the ovary are imbedded many small 
vesicles of a round transparent appearance, in different stages 
of development, which are the ovisacs, containing the ova and 
•are termed G-raaffian vesicles. These vesicles vary in number 
from ten to twenty, and in size from that of the head of a small 
pin to that of a small pea- 

As to the age at which these vesicles are developed, the gen- 
eral opinion is that about a year after birth they can be detach- 
ed in the form of miliary granulations, and that generally 
these granulations progress until they form a small vasicular 
globule. This at first is deeply seated in the substance of the 
organ, but enlarging as they approach the surface, which takes 
place from ten to twelve years, they form when mature small 
projections on the exterior of the ovary beneath the peritone- 
um. 



6 THE WOMB AND ITS APPENDAGES. 

THE OVULUM. 

The future ovum is a very small, globular, nucleated vesicle 
and is contained in the depression of this germinal eminence. . 
The ovum measures from -^{j to rie °^ an mcn * n diameter, 
externally consisting of a transparent envelope, a vitelline 
membrane, and internally, of the yolk ; within the substance 
of the yolk is imbedded a small vesicular body, which is the 
germinal spot. The membrane which is known as the germi- 
vesicle is very fine and transparent, and is about T £ ^ of an 
inch thick ; that which is known as the germinal spot, is not 
transparent, and is of a yellow color, "and its measurement is 

about 3/00 °f an mcn - 

The Graanmn vesicles continue without interruption to devel- 
ope from infancy to the termination of the fruitful period ; but, 
however, the ova are incapable of impregnation until puberty, 
because they are immature. 

There is a gradual approach of Graafian vesicles to the sur- 
face of the ovary, from whence the ovum and fluid contents of 
the vesicles are passed into the fallopian tube. 

THE BROAD AND ROUND LIGAMENTS. 

The broad ligaments are constituted by the peritoneum. Be- 
ing two in number, there is one on each side of the womb, arid 
within their posterior layer are situated the ovaries. In the 
figure here presented, one of these ligaments is omitted in or- 
der to give full view to the ovary. 

The round ligaments are two cords of muscular or fibreous 
nature. They are situated between the layers of the broad 
ligaments, extending from the upper angles of the womb to the 
labia-majora. These cords or ligaments serve to retain the 



MENSTRUATION. 



womb in its proper position in the pelvis, and to draw the an- 
terior surface of that against the parietes of the abdomen dur- 
ing utero-gestation. 



CHAPTER II. 
MENSTRUATION. 

This is a function peculiar to the human female. And it is 
one of vital importance, having dependent upon it vast inter- 
ests. Without the healthful performance of this function after 
it has commenced at puberty, the female economy cannot 
continue in a healthy state. Of course, there are excep- 
tions to this rule ; for instance : where the stoppage is the re- 
sult of pregnancy. 

There are various opinions as to the real nature of menstru- 
ation. By one it is claimed to be a secretion or excrementitious 
secretion unfit to be retained in the economy and therefore 
eliminated. 

By another it is claimed that it is not a secretion, but a hem- 
orrhage of true and venous or capillary blood. By the one 
part that it is not blood, that it contains no blood corpuscles and 
that it will not coagulate. The others contend that it is blood ; 
that it contains all the elements of blood, and that it does co- 
agulate. We coincide with the latter view that it is a hemorr- 
hage, believing the doctrine of secretion to be untenable, This 
hemorrhage is derived from the whole extent of the mucous 
membrane of the uterine surface. One positive argument in 
favor of it being a hemorrhage is, that an analysis of menstru- 
al fluid gives us all the elements found in blood derived from 



8 MENSTRUATION. 

the arm. It is true we have a greater quantity of water in 
the menstrual fluid and smaller quantity of blood globules, 
which is another proof that it is a hemorrhage and from very 
minute capillaries. 

One negative argument, and yet a proof of the most positive 
kind, is found in the non-existence of any arrangement of 
structure in the womb or any where else, by which blood can 
be secreted. Blood corpuscles are solids. Solids cannot be se- 
creted; therefore the menstrual fluid cannot be a secretion. 

All secretions are produced by the delequescence of cells and 
continue so long as there are cells and no longer ; for there can 
be no secretion without cells, and no cells without parents. 
We have then this law of secretion : it may be increased or 
diminished, but never entirely suspended. 

Now, what are the facts as regards the coagulability of the 
menstrual fluid ? Those who tell us that it does not coagulate 
have told us the truth of what they have observed ; but, had 
those writers obtained a quantity of this fluid and carefully ad- 
ded an alkali they would have found it to coagulate. 

The difficulty with them was, they obtained the article sec- 
ond hand. Had they obtained this fluid by placing a speculum 
so as to encircle the cervix uteri, they would have it unmixed 
with vaginal mucous. Remembering the alkaline character of 
the blood, we are not surprised that it coagulates when obtain- 
ed in this manner, and knowing the positive acid character of 
the vaginal mucus, we are not surprised that the blood being 
alkaline, loses its coagulability when brought into contact with 
the vaginal walls. Healthy females frequently find on rising 
from the recumbent position, that a quantity of blood escapes 
and immediately coagulates ; they also observe that which pas- 



MENSTRUATION. 9 

ses while on the feet, does not. The reason is obvious. A 
small quantity of blood being retained in the womb by its po- 
sition, passes out on rising and traversing the canal rapidly, 
does not become mixed with and neutralized by the acid vag- 
inal mucus. 

Its retention in the womb and admixture with its secretions, 
does not destroy its coagulability, as the uterine mucus is of 
the same alkaline nature, as the blood. 

Then believing menstruation to be hemorrhage, and not a 
secretion the question naturally suggests itself: why should 
there be a hemorrhage as an accompaniment or incident of men- 
struation ? If we look to the nature of the process we will see 
this matter in its true light. All organs whose functions are 
periodical as the ovaries during ovalation, the breast during 
lactation, the stomach during digestion, have a special deter- 
mination of blood and nervous influence to the part where the 
functions are to be exercised. This is clearly for the purpose of 
supplying the part with the material more abundantly for the 
secretion of gastric juice. In lactation the determination of 
blood to the mammary glands is for the purpose of supplying 
the parts with material from which the milk is formed, and in 
menstruation the special determination of blood and nerve force 
is to furnish the elements for the evolation of the germ and 
its nourishment. 

CAUSE. 

The cause of menstruation is the following : when the sex- 
ual apparatus has become sufficiently developed, a germ, egg 
or ovum is evolved from the ovarian bed, passes along the 
channel of the fallopian tube into the uterine cavity, and un- 
less impregnated in it course by meeting and mingling with 



10 MENSTRUATION. 

the sperm cell or semen of the male, it is expelled through the 
vaginal passage. This process imparts a stimulus, creates a 
true congestion or hypercemic condition, and usually sufficient 
to create a discharge of blood. A certain amount of disten- 
tion, congestion is necessary to distend the capillary vessels so 
that the fimbriated extremity of the fallopian tube may grasp 
more completely the matured ovum and ^insure its passage to 
the womb, and if the ovum in its passage becomes impregna- 
ted and fixed to the walls of any part of the reproductive chan- 
nel the usual quantity of blood, or some portion of it is need- 
ed to supply the elements for its nourishment and growth, and 
for the development of its appendages. If no impregnation 
takes place this blood will be effused into the cavity of the 
womb and expelled by the vagina. The ovaries, then, are the 
essential elements of menstruation. All evidence shows that 
they are the primary agents of menstruation, for if the womb 
be absent and the ovaries intact we have menstruation ; remove 
the ovaries and menstruation ceases. The phenomena of men- 
struation then are due to the matured ovum rupturing the 
Graafian vesicle, being seized by the fimbriated extremity of 
the fallopian tube and passed into the womb. 

The following conclusions are arrived at on this important 
point : 

Ovaries are necessary to menstruation. 

1. In the ovaries of women who menstruate regularly there 
are a numher of Graafian vesicles seen in different degrees of 
development from the size of a small seed to a pea. 

In an examination of the ovaries, cicatrices may be observ- 
ed, which correspond with the number of menstrual periods. 

2. It is a law of nature that an ovum be discharged from the 
ovary of the human female at every period of menstruation. 



MENSTRUATION. 11 

3. That, ova are produced spontaneously in the ovaries and 
expelled at regular intervals independent of coition. 

4. That the ova are and can be fecundated only after their 
expulsion from the ovary. The membranes by which they are 
protected previous to their expulsion, form an obstacle to the 
access of the spermatic corpuscles the actual contact of which 
is indispensable to the impregnation of the ovum ; and the fe- 
cundation usually takes place in the womb or lower part of the 
fallopian tube. 

The final cause of menstruation is to prepare the uterus for 
impregnation and conception. 

An ovule ripe for impregnation parts from the nest in the 
ovarian bed in which it had been elaborated, being conveyed 
by the grasp of the fallopian fimbria. Nature establishes an 
action for the purpose of preserving it, provided an opportuni- 
ty of becoming impregnated by contact with the male semen 
is afforded. 

The healthful performance of menstruation or elimination of 
the ovum from the ovary, is an indication of a natural condi- 
tion of the female genital organs, and the consequent aptitude 
of the individual for impregnation. Yet, it is not always so, 
for every 'healthy, menstruating female is not fruitful; still 
the appearance of the menses denotes the capability of being 
impregnated, and their cessation the loss of such capability. 
The menstrual discharge is merely an external sign of a gigan- 
tic process that takes place within. It is scanty in some, abun- 
dant in others — depending upon the condition of vascular ac- 
tivity of the system at large,' and the uterine organ in particular, 
and though the bloody discharge is an index of the general ap- 
titude of these organs for successful impregnation, still it is not 



12 THE COMMENCEMENT, CONTINUATION AND CESSATION. 

absolutely requisite. A matured egg, discharged from the 
ovary at the particular period is menstruation, and pregnancy 
is possible. 

Menstruation is a periodical function of the womb, and 
ovulation is the constant function of the ovaries. Ova are 
matured in the ovaries at all ages, but more perfectly during 
menstrual life. 

Ovulation and menstruation being often concurrent, indi- 
cate that they are both the result of the attainment of a certain 
point in the female economy. 

The menstrual flow is a true hemorrhage, the result of ovar- 
ian excitement, which extends itself to the womb, which is the 
seat of functional activity. 



CHAPTER III. 

THE COMMENCEMENT, CONTINUATION, 
AND. CESSATION. 

The age at which the menstrual discharge first makes its 
appearance, is governed by circumstances, such as constitu- 
tion, habits, mode of living, moral training, climate *and other 
circumstances of living. 

In some cases it has taken place at the early age of eight and 
in others it has not appeared until eighteen and twenty. In 
our climate the average age is from twelve to fifteen.. It comes 
on under various circumstances, and frequently very unexpect- 
edly, when the girl may the least think of it. While at school, 
or on the street, or at church; or while engaged in the games and 
sports of girlhood, or in the performance of some of the duties 



THE COMMENCEMENT, CONTINUATION AND CESSATION. 13 

of the home circle, or during the hours of her night slumbers. 
In a word, at any time and under any circumstance is it liable 
to occur, when the time has arrived for its appearance. 

Thus the girl has entered into womanhood, and hence a new 
sphere of existence, and she is rendered susceptible to fecun- 
dation. 

QUANTITY OF FLUID DISCHARGED AT EACH 
MONTHLY PERIOD. 

In numerous cases, females lose too much blood at the cata- 
menial period. This happens from a relaxed state of the ves- 
sels as a result of inflammation. Few indeed escape from such 
debilitating influence, save those who suffer from chlorosis or 
amenorrhea, lengthened observation and a large female prac- 
tice enable me to form a correct rule, respecting the amount of 
menstrual blood, namely : the less the hemorrhage the better. 
Those women that are but little exposed to the excitement, that 
luxurious living and artificial society yield, but, to the contra- 
ry to toil hard and endure many hardships generally lose but 
little blood during menstruation, six to eight ounces is about 
the average quantity of menstrual fluid in temperate climates. 
Though some lose more than twice that amount. Again there 
are considerable numbers of cases, where the quantity does not 
exceed two, and sometimes one ounce. When it exceeds three 
or four ounces, I regard all beyond that as abnormal in quan- 
tity ; it consists of blood largely mixed with mucus. During 
delivery when the mother has a vigorous and elastic state of the 
muscular system and has been uniformly hygienic in her hab- 
its of living, the loss of blood in such cases will be inconsider- 
able compared with what is actually lost in most cases of ac- 

couchment. 

2 



14 THE COMMENCEMENT, CONTINUATION AND CESSATION. 

THE EFFECT MENSTRUATION HAS UPON THE 
FEMALE. 

These effects are remarkably striking. The figure enlarges, 
becomes rounder, more robust, more fully formed, the pelvis 
expands, the breasts enlarge, the deportment is graceful, dig- 
nified and perfect. 

The change of the mental faculties is wonderful ; the cere- 
bellum increases in size, the games, amusements, habits and 
pursuits of girlhood are exchanged for high and holy interest 
of womanhood ; and the keen and exquisite intuition of the 
new relations higher heaven born enjoyments veiled by a more 
delicate modesty. These changes are rapid and fit the female 
for a new and extended sphere of existence. 

ITS CONTINUANCE. 

This function having commenced at from twelve to fifteen, or 
as the case may be, continues to recur every twenty eight days, 
until about the age of from forty to fifty. Every month an egg 
is thrown off from the ovary, passes down the fallopian tube, lod- 
ges in the womb and unless fecundated is expelled as an abor- 
tion, and though she passes one single egg per month, she pro- 
duces no less than four hundred and twenty-four during her 
life time. Many women throw off from two to five at each 
monthly period ; hence, twins are no very uncommon occur- 
rence, not to refer to cases where three or even more infants are 
born at once. At about the above age the function of menstru- 
ation ceases. The female loses the power to menstruate. The 
germ manufacturing power is exhausted. Not a single Graaf- 
fian follicle is left in the ovaries, they are shrunken and shrivel- 



THE COMMENCEMENT, CONTINUATION AND CESSATION. 15 

led forever, menstruation has disappeared, because the month- 
ly ovulation has ceased to be a physiological function. 



THE CESSATION OF THE MENSES OR CHANGE OP 

LIFE. 

The period of the final cessation of the menses, is variable ; 
the change is attended even in healthy women, by phenomena 
demanding discrimination, and generally excites the fears of 
women. It often happens that the uterine functions acquire 
an increased activity before their final cessation, so that wo- 
men who have not had children for years or who have been 
barren, hitherto, have unexpectedly become pregnant ; but it 
more frequently happens that women mistake the symptoms at- 
tending the cessation of the menses, for those of pregnancy. 
The passing over of the menstrual period, swelling of the 
breasts, the sickness and disorder of the stomach and capricious 
state of the appetite, the increase in size and the movements 
caused by flatulence of the bowels often accompanying this epoch 
frequently induce a belief in the mind of even experienced 
women that they are pregnant ; and their real state can be de- 
termined only by an examination, by time, or by the exhibition 
of pergatives. Menstruation seldom ceases at once, when the 
usual age for its disappearance has arrived, unless some acci- 
dental circumstance, such as fright, exposure to cold, an acute 
illness and the like occurs, to cause it; on the contrary, the 
change is usually gradual, as to the intervals between the du- 
ration of the periods, and the abundance or scantiness of the 
flow. The discharge may return every two weeks, then cease 
for several weeks, or months, and afterwards recur for a few 
periods, as regularly as ever, and then altogether stop. 



16 THE COMMENCEMENT, CONTINUATION AND CESSATION. 

This change has been very properly called by many "the 
critical age." In view of its importance, females generally 
look upon it with a great degree of anxiety. And have they not 
a just reason for thus feeling anxious ? Remembering the many 
difficulties that frequently develope themselves at such a period, 
and the great danger they are exposed to, they have. It is 
true that very many females of a very delicate constitution, up 
to the period of this change, and who have been liable to hyster- 
ical and nervous ailments, have afterwards enjoyed a much better 
state of health, and lived long and healthy, when this change 
has been carefully brought about. During the functional ac- 
tivity of the uterine organs, and while these organs are highly 
susceptible of irritation, many of the diseases depending upon 
the irritation of them are more or less frequently experienced ; 
but when these organs undergo the change of life, the suscepti- 
bility of irritation subsides, and gradually disappears; and 
consequently, the diseases which thus originate are no longer 
felt. 

But, while the above may be the case, there are a large num- 
ber of women with whom various difficulties arise, often when 
disease exists, or even a predisposition to disease, the cessation 
of the menses generally assists in aggravating the former or de- 
veloping the latter. A disease that may have been so slight 
as to be unnoticeable, as long as the menstrual discharge has 
continued, may no longer remain latent, but assume an active 
and rapid form. 

Some of the diseases which follow this change, are : Verti- 
go, hysterics, colic, piles, cutaneous eruptions, ulcers of the 
layer, hemorrhage from different parts, dyspepsia, palsy, apo- 
plexy, insanity, paralysis, liver disease, dropsy, structural 



THE COMMENCEMENT, CONTINUATION AND CESSATION. 17 

changes in the lungs, cancer of the breasts and uterus, profuse 
sweats. 

This period is always more critical to plethoric women than 
others. They are more liable to attacks of hemorrhage, 
and in their management the physician should exercise the 
greatest care ; a spare diet should be enjoined, regular exer- 
cise, the secretions well attended to. 

SYMPTOMS. 

This period is ushered in invarious ways ; but there is always 
more or less lassitude, debility, headache, aching in the back 
and limbs, flushes of heat occuring in paroxysms, sometimes 
often, in other cases more rare ; arrested secretions, and dys- 
peptic symptoms. 

Among healthy females, however, it is not common for them 
to suffer much. They generally become stouter, and the ab- 
domen and breasts frequently enlarge to such an extent as to 
lead them to think they are pregnant. The discharge usually 
diminishes, gradually, assumes a paler color, and eventually 
ceases permanently ; but may occur at uncertain or distant per- 
iods, or alternate with a white discharge. Sometimes there 
will be a profuse bloody discharge, and the function becomes 
suspended for the remainder of life. Among delicate females, 
and those who have suffered from previous diseases of menstru- 
ation, it is not uncommon to meet with excessive Menorrhagia 
or severe and repeated attacks of uterine hemorrhage joper- 
dizing life. This may be said of those who have been intem- 
perate in their passions and pleasures. The symptoms attack- 
ing these vary considerably ; much pelvic irritation with a 
bearing down sensation, a desire to stool, or a forcing back- 



18 DISORDERS OF MENSTRUATION. 

wards, frequent inclination to urinate, heat and smarting of the 
parts, and tenderness of the vagina are very apt to be present. 
A troublesome itching of the parts of generation is a common 
accompaniment. The person becomes irritable, uneasy, rest- 
less, with more or less changes in the moral and mental dispo- 
sitions. With some the skin loses its color and suppleness , 
becomes sallow and wrinkled, the hair falls out or turns gray,, 
the breasts, at first placid and pendulous, finally disappear, and 
the voice becomes masculine. 

At this period of life we often find the womb greatly congest- 
ed, its walls thickened and much enlarged — a condition very 
apt to cause displacement if the vaginal walls are relaxed. 

This is an important matter to attend to, because a displaced 
womb is a disturbing force in the economy. The nervous sys- 
tem and the womb are intimately connected with the systems of 
voluntary and ganglionic innervation, and no woman can feel 
well with a displaced womb. Sometimes the displacement may 
be simply due to relaxation and the uterus is heavier, larger, 
more solid then it ought to be. 



CHAPTER IV. 

DISORDERS OF MENSTRUATION. 

The functional derangements of menstruation'are divided in- 
to three classes. 

1. Amenorrhea, 

2. Dysmenorrhea, 

3. Menorrhagia. 



DISORDERS OF MENSTRUATION. 19 

AMENORRHEA. 

By amenorrhea is understood, first, retention of the menses 
or catamenial flow beyond the natural .time, from constitu- 
tional causes or mechanical obstructions ; secondly, a partial 
or total suppression of already established menses, from phthi- 
sis, debility, chlorosis, fevers, cold damp, pregnancy. 



CAUSE. 

Retention of the menses is caused by a natural or acquired 
delicacy of constitution, combined with the lymphatic temper- 
ament a highly sensative nervous system. A certain amount of 
stamina or physical and nervous energy, is essential to the per- 
formance of the menstrual function, and just so long as the or- 
ganism is without this force, all the functions are imperfectly 
performed. Organic disease of the lungs, kidneys, liver, heart 
and strumous ulceration, and such diseases operate as causes of 
retention, and also of suppression. 

Malformation of the uterine organs, ovaries wanting, dis- 
eased and atrophied ; the womb may be absent, vagina imper- 
fect, unnatural growth of the womb or vagina and other me- 
chanical causes. 

By simple amenorrhea, is to be understood that form, where 
the sexual system is developed, the signs of puberty present, 
but where no discharge escapes from the vagina. The subjects 
of this form embrace the very opposite conditions — plethora and 
anemia. In the first case there is a super-abundance of blood 
in the system. In the latter there is a deficiency of blood in 
the system, or a want of red globules in the blood. 



20 DISORDERS OF MENSTRUATION. 

SYMPTOMS. 

Pale, wax-like, or sullen sickly appearance ; furred tongue, 
foul breath, variable and sometimes morbid appetite, nausea 
general debility, lassitude and sense of fatigue, pains in the 
small of the back, pelvis, abdomen, head, side and limbs, 
disinclination to mental or physical exertion, coldness of the feet 
constipation, leucorrhoea, depression of spirits, melancholy, 
dyspeptic symptoms, fullness of the abdomen, faintness, palpi- 
tation ef the heart, rigid pulse, headache, vertigo, roaring in 
the ears, hystercal symptoms, hemorrhage from the nose, stom- 
ach, lungs, or rectum, ulcers, &c, &c. 

SUPPRESSION OP THE MENSES. 

Suppression of the menses is when after having made their 
appearance they cease to return at the proper period. This 
may arise from a natural cause as pregnancy or from debility, 
resulting from a loss of blood, from a chronic or acute disease, 
mechanical obstructions, inordinate discharges, or "excess in 
muscular exertion ; it may occur suddenly from violent emo- 
tions of the mind, exposure to cold, damp bath, or any other 
cause that abruptly shocks the system. This obstruction is 
apt to take place if the patient goes from a warm room, af- 
ter exercise when the pores are open into cold air, insufficient 
clothing, thin soled shoes are frequent causes, violent mental 
motion, as grief, joy. 

The menstrual derangement has often approached gradually 
and is but a symptom of some other disease, as scrofula, chlo- 
rosis and consumption, and when connected with the latter dis- 
ease, it may be considered as a very unfavorable condition. 

But suppression does not only occur with those that are 
weakly, but with the most sound and robust constitutions as 



DISORDERS OF MENSTRUATION. 21 

well. The amount of disturbance consequent upon the sudden 
arrest varies a good deal ; generally, fever, headache, hot skin, 
quick pulse, mental disturbance, neuralgia, derangement of the 
senses. 

VICARIOUS MENSTRUATION. 

This is often met with in amenorrhea. It is an effusion of 
blood without reference to location. It usually occurs at the 
menstrual period. The locations from which this vicarious 
discharge takes place are as follows : the nostrils, eyes, ears, 
gums, stomach, anus, bladder, nipples, ends of the fingers and 
toes, skin, ulcers, varicose excrescences. It has all the appear- 
ance of the catamenial fluid ; dark colored and thin. The ap- 
pearance of this discharge at these particular points may be 
perfectly periodical, but as soon as the womb can be stimulat- 
ed to resume its functions, the vicarious discharge will cease 
and menstruation will become normal. 

DYSMENORRHEA OR PAINFUL MENSTRUATION. 

Dysmenorrhea is the term applied to menstruation which is 
attended with more or less distressing pain, it is sometimes very 
unyielding in its nature, continuing until the turn of life. 
The pain may be moderate or it may be very violent, render- 
ing the patient a permanent invalid from its repeated shocks to 
the constitution. It may occur shortly before the appearance 
of the catamenia or at the same time, with it; and sometimes 
does not come on until near the termination of the flow. The 
character of the pain and the accompanying symptoms vary ac- 
cording to the constitution of the person. The seat of pain 
may not be in the womb, but in the ovaries, or in the flexus of 



22 DISORDERS OF MENSTRUATION. 

nerves supplying the womb, or in the limbs, or in the bladder, 
rectum, urethra, or all combined. The pain of dysmenorrhea 
is not only differently located, occupying different organs and tis- 
sues, but it is sometimes tenesmic, sometimes neuralgic, some- 
times all combined, terribly lancinating accompanied with dis- 
tress, aching, burning, bearing down, sometimes cramping and 
spasmatic. There is a large number of women that suffer from 
this distressing disease ; women of all ages and conditions of 
life. 

This disease is divided into three varieties, viz: neuralgic, 
inflammatory and mechanical. 

NEURALGIC DYSMENORRHEA. 

This variety is generally met with among delicate and ner- 
vous females. The menstrual discharge is either preceded or 
followed by headache, which sometimes alternates with pain 
low down in the back, and extending to the lower part of the 
abdomen and down the thighs. The pain may be constant or 
it may come in paroxysms, with intervals of ease, and it is fre- 
quently so violent as to be almost insupportable. It usually 
lasts fjom six to twelve hours, when the appearance of the flow 
relieves it in a great measure. The discharge may be dimin- 
ished, paler than usual, and mixed with clots ; and sometimes 
there is a membrane passed, looking somewhat like the thin 
skin situated between the white and shell of an egg. If this 
distress in this disease is not relieved a state of mental and ner- 
vous excitement, mental irritability, which is often regarded as 
insanity, supervenes. The same general causes that produce sup- 
pression of the menses further derange the health of a nervous 
or nervo-bilious temperament ; the pain is evidently ovarielgia, 
deep seated purely neuralgic. This form of the disease is only 



DISORDERS OF MENSTRUATION. 23 

known among the highly civilized, being altogether unknown 
among persons who lead primitive and natural lives. When 
we reflect on the habits and modes of life of modern women we 
do not wonder that this important function should be so often 
disturbed. The perfect form of woman was created in beauti- 
ful symmetry for the healthful exercise of all the organs, but 
civilized woman baffles divine care and makes her an artificial 
thing, recognized and known as a specimen of fashion, envel- 
oped in corsets and stays — a whalebone and buckram casement, 
cheating nature out of her fair proportions . 

The exciting causes are cold, sudden check to the perspira- 
tion, sudden shock, mental emotions, acting upon an irritable 
nervous system. 

INFLAMMATORY Ott MEMBRANEOUS DYSMENORRHEA. 

This form is more common to plethoric women or those of 
full habit, and those of a sanguine temperament, and in the 
married as well as in the single, but more generally at 
a late period of life. Suffering begins four or five days before 
each period; a degree of restlessness, feverishness, regors, 
flushing, headache, backache, generally precede the severe 
symptoms. For sometime before and after the catamenia ap- 
pear, the suffering is intense ; the patient complains of weari- 
ness and restlessness, intolerance of light, the face is flush- 
ed, skin hot, pulse full, quick, bounding, throbbing pain 
in the womb. Discharge comes on gradually ; scanty at 
first ; relief follows abundant flow, clots, and shreds or flakes 
of membrane expelled ; sometimes pear shaped cests of the uter- 
ine cavity, formed of epithelial membrane of the womb analo- 
gous to decidua, womb congested, neck edematous, ovaries ten- 
der, swelling and tenderness of the breast. 



24 



DISORDERS OF MENSTRUATION. 



MECHANICAL DYSMENORRHEA. 

In this form we have some mechanical obstacle, as a stric- 
ture of the external or internal os uteri, or a narrowing of the 
entire canal or uteri and displacement retroflexion or ante- 
flexion, narrowing or cartilaginous condition of the entire cer- 
vical canal. These conditions cause sterility as well as dys- 
menorrhea. 

SYMPTOMS. 

The symptoms in this variety of the disease or obstruction 
to the menstrual flow : a scanty flow, discharge escapes in gush- 
es, each one attended with great pain in the back, pain and ir- 
ritability of the bladder, congestion and tenderness of the ova- 
ries. On examination the physician finds a very small os uteri 
or an orifice of normal size, stricture being detected by the in- 
troduction of the uterine sound. 

MENORRHAGIA. 

This is a term applied to all large discharges of blood which 
takes place from the womb. Profuse hemorrhage may occur 
at any period of life from puberty to old age, in every variety 
of constitutions, although the sanguine are more obnoxious to 
it. The most common form of menorrhagea, is that which 
happens during the period of menstruation from a congested or 
relaxed condition of the secretary vessels of the womb. The 
temperament, constitutions, habits of life, have a particular in- 
fluence over the quantity of the menstrual flow, its natural 
flux becomes morbidly augmented thus we apply the term 
menorrhagia. This in moderate discharge may exist in two 
ways ; the menstrual flow may appear every two or three weeks, 



DISORDERS OF MENSTRUATION. 25 

instead of every four, or it may occur at the regular time, but 
in profuse quantity, or it may occur at unexpected and uncom- 
mon seasons, or during pregnancy, or in early months of suck- 
ling. Dangerous uterine hemorrhage occurs from very many 
causes. It may arrise from all diseases that produce anmiae 
tuberculosis, Bright's disease, affections of the spleen and liver, 
undue lactation, anger, grief, passion, violent, physical and 
mental exertion at monthly periods, excessive sexual inter- 
course, metritis and ovaritis, relaxation of the uterine tissue, 
uterine and ovarian tumors, polypus. It may occur during 
pregnancy from disturbance or rupture or plecenta and also 
from plecenta preavia. 

SYMPTOMS. 

The symptoms of monorrhagia are governed altogether by 
the nature of the case. If it be of a mild form, the patient ex- 
periences a sense of lassitude, weariness, faintness, a sensation 
of uneasiness in the back and limbs, debility, an indisposition 
to exercise, a fainting feeling in the pit of the stomach, cold- 
ness, the surface cold and pale, and feeble breathing. But in 
a case of a more serious nature the symptoms are much more 
alarming. Seemingly the patient becomes almost bloodless, 
and she has a blanched appearance of the skin, muscular pros- 
tration, pulse feeble and rapid, restlessness, syncope, and the 
blood flows upon the least exertion, the change of position 
coughing, sneezing and vomiting effecting it, so # that she is 
compelled to be exceedingly quiet. 

CAUSES. 

The causes are some peculiar diathesis, hemorrhagia espec- 
ially, sanguineous temperament. Other causes are irritation, 

, 3 



26 GENERATION, CONCEPTION AND IMPREGNATION. 

congestion or inflammation of the womb. Also tight lacing, ex- 
cessive use of strong tea or coffee, cold, strong passions, abuse 
of stimulants, excessive sexual indulgence, and everything that 
will cause debility of the womb. Its periodical character ser- 
ves to distinguish it, though it may be connected with polypus. 
Menorrhagia, having its origin in organic derangements of the 
womb, like indurations, cancers, tumors, ulcers, will be ac- 
companied with the symptoms peculiar to those maladies. 



chapter v. 

GENERATION, CONCEPTION AND IM- 
PREGNATION. 



It is a fact uncontrovertable, that throughout the domain of 
living organism, impregnation depends on the union of certain 
elements furnished by male and female organs, each of which 
is indispensably necessary to the future being. From the hid- 
den nature of the process and the stupendous results, the sub- 
ject is one of the grandest interest ; but it requires but little 
knowledge of human history to enable us to understand that 
the future being, bodily, intellectually and morally is depend- 
ent upon the conditions of the sperm cell and the germ cell, 
furnished respectively by the male and female parents ; the 
principle involved here, is of immense practical importance, to 
the qualities of the fetus, the youth and the adult. 



GENERATION, CONCEPTION AND IMPREGNATION. 27 

Effects like their causes, are eternal, and this law imposes a 
duty upon parents not generally recognized. It is true, that 
correct training, proper moral culture, may do much to enable 
a frail imperfectly organized embryo to become a good adult, 
but they never possess the stamina of those from perfect germs. 

The formation of seminal animalculae in man and in the 
ovum in the female, belongs to the domain of organic life, yet 
all the powers of the mind are engaged in the work. 

The soul forms the cortical substance of the brain, and from 
this the whole nervous system is supplied ; and it is the ner- 
vous system that expresses all the differences of organization, 
the nervous system that acts upon blood tissues, that creates 
growth, builds up the body. It is a law of nature that two 
human beings have the power of generating a third— of form- 
ing it according to their own capacities. They have the pow- 
er to make a noble soul, or one too weak to form its body. Each 
generate their own portion, so that the embryo is strong or 
weak, according as the parents were in harmony with nature 
and compatible in temperament. The generation of human be- 
ings is performed by the male and female organs, the testes 
and ovaries acted on by every attribute of the mind, modified 
by every circumstance and action. 

The sperm cell is the result of the action of the testicle. It 
swims in a fluid substance like albumen, formed partly in the 
testes and partly secreted by the prostrate gland. In full 
health and vigor, the zoosperms are numerous and active ; in 
sickness or exhaustion, they are few, weak, and in certain 
states of the system entirely disappear, and of course fecunda- 
tion is impossible. The seminal fluid containing the sperm cell 
passes through vasa deferentia up the spermatic cord, passes 
through the wall of the abdomen, and is received with the pros- 



28 GENERATION, CONCEPTION AND IMPREGNATION. 

trate fluid into the seminal ducts, where it is retained until ex- 
pelled. 




SPERMATOZOA OF THE HUMAN MALE. 

A.— The spermatozoa, consisting of a flattened head and long tapering^ 
tail. B.— Three granular tubercles, or seminal granules, from which th& 
spermatozoa are developed. C— The Spermatozoa from the developed 
granules, lying by the side of each other within the vesicle. After a 
while the break forth, but still adhere for a short period. 

The Zoosperms retain their power of motion for hours, and, 
often days after being ejected. Carried up the vagina in hu- 
man generation, by the male organ, it is undoubtedly the de- 
sign of nature that the spermatic fluid should be thrown into 
the mouth of the womb, and then by the contraction of that or- 
gan forced upwards. But to this there may be certain obstac- 
les ; the male organ may be too short to reach the interior, 
there may be malformation, and therefore impregnation pre- 
vented ; the womb may be too low, as is often the case in pro- 



GENERATION, CONCEPTION AND IMPREGNATION. 29 

lapsus or falling of the womb ; the point of the male organ 
may pass into the deep folds of the vagina, and impregnation 
prevented from that cause. 

The only conditions necessary for impregnation are the con- 
tact of the living sperm cell with the matured ovum, within the 
sexual apparatus of the female. 

The old doctrine was that impregnation took place in the 
ovary, and that during pleasurable intercourse, the fimbriated 
extremity of the fallopian tube grasped the most ripened ovum, 
released and detached it from its ovarian bed, transferred it to 
the fallopian tube. This theory, however, has been demon- 
strated to be incorrect. Pleasurable or even conscious congress 
are not necessary in impregnation. Impregnation and concep- 
tion has taken place under the influence of sleep, narcotics or 
by forcible means. 



WHERE DOES IMPREGNATION TAKE PLACE ? 

This question has attracted a great deal of attention. There 
are various opinions relative to this subject. There can be 
little doubt, however, but that it may occur in the ovary, fal- 
lopian tube or womb. Which is the normal locality? The 
egg is ready for impregnation as soon as it is detached from the 
ovary. The conditions necessary to the accomplishment of this 
work are the actual contact of the male semen or its sperma- 
tozoa with the egg or Graafian vesicle. As an effect of this 
contact or successful intercourse the womb, fallopian tubes and 
ovaries become excited, which excitement lasts for sometime 
and during which an alteration in relation to the different parts 
takes place. 



30 GENERATION, CONCEPTION AND IMPREGNATION. 

In my opinion there can be little doubt that normal concep- 
tion takes place in the womb. There is no doubt, but that 
sexual union takes place before the escape of ova from the 
ovary, if sufficient time elapses for the seminal fluid to reach 
the ovary before their extrusion takes place in such cases fe_ 
cundation is effected in the ovary. This sometimes occurs as 
in ovarian fetation ; the ovum receiving the fertilizing influ- 
ence immediately on quitting the ovisac or before it has been 
extricated from the ovary. Sexual desire in the human female 
is the strongest at maturation of the ova, yet, is by no means 
absent at other times; and the occurrence of cases in which im- 
pregnation take place at a single coitus in the middle of the in- 
terval between the menstrual periods proves that either the ovum 
may retain its capacity for impregnation for sometime after its 
escape from the ovary, or that its maturation and extension, are 
by no means invariably coincident with the menstrual period. 
If we accept the doctrine that impregnation commonly and nor- 
mally takes place in the ovary instead of in the womb, the man- 
ner in which the spermatozoa find their way there is very diffi- 
cult to solve. But a fact in favor of the theory of womb impreg- 
nation, is, that, as a general rule, sperm is most frequently 
found in the cornea of the womb ; impregnation can only occur 
where sperm exists. Artificial impregnation has never fecun- 
dated ova, but in the womb. The discharge of the matured 
ova from the ovaries takes place independently of sexual inter- 
course. Therefore, it seems unnecessary that the seminal fluid 
should reach the ovarium, in order to effect fertilization of the 
ova, since this end can be accomplished by contact of the two 
in the fallopian tube, or which is better in the womb. 



CORPUS LtTTBUM OF MENSTRUATION, ETC. 31 

CHAPTER VI. 

CORPUS LUTEUM OF MENSTRUATION 
AND CORPUS LUTEUM OF PREG- 
NANCY. 

When the Graafnan vesicle discharges its contents atthe men- 
strual periods, the cavity is filled with blood, which soon coag- 
ulates and is retained in the interior of the vesicle. In conse- 
quence of the absorption of its serum, the clot contracts and 
hardens ; the coloring matter is somewhat absorbed, and the 
membrane of the vesicle becomes hypertrophied and convoluted, 
and partially fills the cavity. The membrane of the vesicle 
continues to enlarge for about two weeks, at which time the 
vesicle has so solidified as to receive the name of corpus luteum. 
At that period, its appearance is of a rounded form, on the 
surface of the ovary ; its size is about half an inch in thick- 
ness and three-quarters of an inch in length. It bears on 
its surface, a cicatrix, corresponding to the spot on the original 
rupture. After this time, the corpus luteum diminishes in size 
and after the fourth week, its longest diameter is not over three - 
eights of an inch, and during this period the whole body may 
be extracted from its ovarian bed. As the corpus luteum con- 
tinues to retrograde, its yellowish hue changes to a brighter 
yellow ; its surface may be mistaken for the central coagulum 
and adjacent tissues, and in little over two more months it di- 
minishes to a yellow scar, which disappears in seven or eight 
months. In a healthy woman who has never been pregnant, 
but who has menstruated regularly, the ovaries will present 



32 CORPUS LUTEUM OF MENSTRUATION, ETC. 

several corpora lutea differing in development and retrograda- 
tion. 



COKPUS LUTEUM OF PREGNANCY. 

The corpus luteum, after impregnation has taken place, is 
not larger than a small pea, and sometimes smaller, and about 
the approaching menstrual period, it becomes less. 

We distinguish the true and false corpora lutea, by the rap- 
idity of development and the decay ; pregnancy undergoes 
the same changes in the meanwhile, yet more slowly ; hence, 
the size it attains is larger, the organisation firmer, and the 
period at which it disappears is much later. The further mat- 
uration of the ova is dispensed with till after the completion 
of the period of gestation, because pregnancy has arrested the 
process of ovulation. Therefore, during advanced pregnancy, 
the corpus luteum is unlike that of menstruation, accompanied 
with unruptured vesicle in active progress of development. 
After parturition has occured, it rapidly diminishes, though 
for months afterward, its peculiar structure maybe seen. The 
number of corpora lutea in triplet pregnancies correspond to that 
of the fetuses, and are all similar to each other. In some cas- 
es, however, while a single fetus is found in the womb, ovaries 
contain two corpora lutea of the same appearance, one of which 
may belong to an embryo which was blighted in the early stage 
of pregnancy. Several characteristics have been given to en- 
able us to distinguish the false or virgin corpora lutea from the 
true or those of pregnancy. These we think unnecessary here 
to mention. Suffice it to say, the corpus luteum of menstrua- 
tion, after a month has elapsed, is- much smaller than the cor- 
pus luteum of pregnancy at that early period. 



DIFFERENCE BETWEEN IMPREGNATION AND CONCEPTION. 33 



CHAPTER VII. 

DIFFERENCE BETWEEN IMPREGNATION 
AND CONCEPTION. 

In the begining of this chapter it is important that we should 
draw a line of distinction. The notion is entertained by most 
of people, about nine in ten, that impregnation and conception 
or pregnancy are the same. Or if they suppose them to be 
separate proceses, they are not able to explain the difference. 

It has already been said, that a certain change takes place 
at a certain period in the life of the human female. A certain 
amount of sanguineous fluid is eliminated from the womb and 
escapes through the vagina. Having occured at the age of 
twelve, of fifteen, or there about, it recurs every twenty eight 
days until from forty to fifty, unless hindered by some abnor- 
mal condition of health, or by a natural cause such as preg- 
nancy 

At each of these monthly periods, a germ cell, egg or ovum 
is evolved from the ovarian bed, passes along the fallopian tube 
into the cavity of the womb, from whence if nothing interferes 
it is expelled with the menstrual discharge. During its pas- 
sage from its starting point to the cavity of the womb, should 
this germ cell, egg, or ovum, be met and commingle with the 
sperm cell or semen of the male, impregnation has taken place. 
Impregnation, then, depends upon the union and comming- 
ling of the germ cell and the sperm cell. Whenever, in the 
generative passages of the female, the living spermatozoa come 
in contact with ripened ova, then impregnation occurs. But 



34 GESTATION. 

the ovum may be fecundated by intermixing with the elements 
of the sperm cell, without conception resulting. The fecun- 
dated ovum may be expelled as in the ordinary process, of 
monthly ovulation. Many cases of sterility are attributable to 
the inability of the womb to retain the ovum after it is im- 
pregnated, in consequence of weakness, relaxation or leucorr- 
hoe. 

Conception or pregnancy is a separate part of the work of 
nature though it must depend upon impregnation. It suc- 
ceeds the later as a consequence . How soon it takes place is 
a question that has not been settled. The time varies much 
with different females. What is conception ? It is the attach- 
ment or fixation of the impregnated germ cell, egg, or ovum, 
to the place where it is to be developed until the time of birth. 

The difference, then, is very beautiful as well as very impor- 
tant. Impregnation is the union and commingling of the two 
elements, conception the fixation of them to the uterine walls. 



CHAPTER VIII. 

GESTATION. 

Let us, before proceeding to investigate the development of 
the ovum, briefly examine the changes which impregnation 
occasions in the womb, and prepare it for the reception and 
nutrition of the new being. 

Conception is accompanied or immediately followed by con- 
gestion of the womb. Its vessels are filled with blood, and 
gradually enlarge till they become of a great size. Although 
many of them did not carry red blood before, and on that ac- 
count, were invisible, now become prominent and form a beau- 



GESTATION. 



35 



tiful network on the surface and in the substance of the womb. 
The arteries thus not only become distended, but their coats 
thicken to meet the increased work they have to do. The veins 
undergo a like change, admitting of great distension, as seen 
in the annexed cut; and in certain places, this is so marked, 
particularly near the plecenta or after birth , that they have 
been termed the uterine sinuses. The nerves of the uterus, 
which are so minute in the unimpregnated womb, increase rap- 
idly in size until near the termination of pregnancy, at which 




THE PREGNANT WOMB WITH ITS CONGESTED 

VESSELS. 



time they become like cords, very numerous, they ramify and 
anastomose with each other, sending out numerous periph- 
ery. By these changes are quickly brought about a change 
in the womb. Here we have an increase of nervous ex- 
citement, there a determination of blood, and there we have 
a rapid increase of substance of the proper tissues of the 
womb. • This process of growth is necessary to the new being. 
There is a separation and enlargement of fibres, and blood ves- 



36 GESTATION. 

sels, interwoven between, sprout out, as also nerves and lim- 
phatics of a near and independent origin. Distensibility be- 
comes great, fully equal to the growth of the child. The dis- 
tension of the womb is not accompanied with any thinning of 
its walls, but. which may seem to be strange, a thickening of 
about half an inch and sometimes more, over and near the place 
where the after-birth is attached. The increase in the size of 
the womb commences at the fundus or upper part, immediate- 
ly after the descent of the ovum, and this is developed, the 
body or that part from the fundus to the neck enlarges, and af- 
terwards the neck. 

During the early months of pregnancy, the womb is con- 
tained in the cavity of the pelvis, but very soon after the fourth 
month, the fundus or the upper part of the uterus can be felt 
above the symphysis pubis ; as the process continues, its ascent 
is gradual, till by the fifth month, it reaches midway between 
the pubis and umbilicus imparting a rotundity to the lower por- 
tion of the abdomen ; but about the end of the sixth month, it 
reaches as high as the umbilicus which it somewhat protrudes ; 
during the seventh month it descends midway between the um- 
bilicus and ensiform cartilage, and, at the expiration of the 
eighth month, it reaches the ensiform cartilage, filling the ab- 
domen and pressing the intestines behind and above it ; during 
the ninth month, though increased in size, it does not ascend, 
but rather, from the yielding nature of the parts, descends low- 
er then previously ; but its capacity is otherwise immensely 
increased. During this process there is a most remarkable 
change in the cervix or neck of the womb. In the early months 
it becomes swollen, but soft, elastic, cushion-like ; but later, 
the os uteri loses its defined form, and becomes slightly dilat- 
able. The canal through the neck, in the early months, is 



GESTATION. 37 

closed by the glutinous secretion of the follicles. Owing to 
its increased weight, during the first three months the os uteri 
is lower in the pelvis than in its unimpregnated state, and its 
mouth is directed a little forward. About the fourth month, 
and even to the fifth, the womb rises above the brim of the pel- 
vis, the mouth is directed backward and the neck shortened, 
evidently from the womb being expanded. About the sixth 
month the neck of the womb loses more than one-fourth of its 
length ; during the seventh, one-fourth more ; at the eight, 
a quarter, and about the ninth month it is perfectly gone, 

The shape of the womb at full term, is oviform, the larger 
end being uppermost and rounder in proportion to the lower 
end ; but pressure of the surrounding parts may cause varia- 
tions in shape to occur often. The axis of the womb at the 
end of gestation, is ordinarily more perpendicular than that 
of the brim of the pelvis ; but uterine contraction rectifies this, 
which tilts the fundus forward. 

The impregnated ovum, when it is about to descend into the 
cavity of the womb, the mucous membrane of that organ as- 
sumes an increased activity and growth. It assumes also a 
congested, tunefied, vascular appearance, and increases in 
thickness, its surface is formed into round projecting eminen- 
ces or convolutions. 

The villi elongate from this turgid condition, and throw off a 
thin, pulpy, semi-fluid substance, which is secreted from the 
mucous membrane, which is termed the decidua. This mat- 
ter very soon acquires consistence, and resembles coagulum, 
and lymph. It lines the whole cavity of the womb. When 
conception occurs, this exudation covers the entire inner sur- 
face of the womb, constituting a soft pulpy membrane. 

It is as yet, an unsettled question, as to whether this decidua 

4 



38 GESTATION. 

is a changed condition, a special development of the mu- 
cous membrane, or a new formation. There is little doubt in 
my mind, but that the membrana decidua is a distinct secre- 
tion. It is supposed by some, that the mucous membrane of 
the womb is actually thrown off at each monthly period with the 
non-impregnated ovum. This mucous membrane, which is 
supposed to be cast off has received the name of false decidua, 
in contradistinction to the true decidua of pregnancy. 

This view we believe to be incorrect. The mistake, no 
doubt, consists in regarding a morbid excretion, as if it were a 

normal secretion ; but there is no evidence that this false de- 

« 
cidua has any existence whatever in healthy females, with nor- 
mal menstruation. We have no doubt it can exist ; but then 
it is a product of inflammation, analogous to croup or catarrh. 
We have a like excretion from inflammation in dysmenorrhea. 
In all cases the mucous membrane is in a state of chronic in- 
flammation, which excreates effete matter. 

It concretes and hardens, and becomes a preternatural mem- 
branous covering. Sooner or later it is thrown off, being ex- 
pelled by the process of sloughing. In many cases this false 
membrane is cast off from the entire inner surface of the womb, 
in the form of a cyst or sac, containing a fluid ; but in the 
most of cases it is thrown off in pregnancy of greater or less 
consistency and tenacity. The passage of this membrane is 
termed dysmenorrhea or painful menstruation, and escapes 
from the womb at each monthly period. The pains attending 
the efforts of the womb in the expulsion of this abnormal pro- 
duct, are often so severe as to be agonizing. The most ra- 
tional opinion seems to be that the decidua though projecting 
from the mucous membrane of the womb is not the mucous 
membrane itself. At an early period the decidua is rough 



GESTATION. 6 

externally and smooth internally. It is a redish, whitish, 
gray color. Its thickness varies in different places ; it is thick- 
er than the plecenta or after-birth ; thinner near the neck of 
the womb ; and it becomes thinner as pregnancy advances, till 
it is formally expelled, more or less, entirely with the fetal 
membranes. 

Physiologists have not yet fully determined the arrangement 
and structure of the decidua. It is the opinion of some that 
impregnation takes place normally in the ovary, that the decid- 
ua is formed before the arrival of the ovum in the womb, and 
that the ovum, passing into the cavity of the uterus, becomes 
involved in the secretions, and absorbs a portion of it for nu- 
trent material while the remainder is organized into a double 
membrane, corresponding to the womb, the other adhering to 
the ovum. If this view is accepted, when the ovum reaches 
the corner of the womb it pushes the decidua before it, the 
projecting portion constituting the tunic of decidua reflexa, 
which envelops the whole ovum, except the part where the de- 
cidua is detached from the womb which is the seat of the fu- 
ture plecenta or after-birth. There are others who believe the 
structure of the decidua and the decidua reflexa to be different ; 
they regard the decidua vera to be a new production, the de- 
velopment of which takes place at the same time with the ovum. 
Just at the point of supposed reflexion, a substance is found, 
exactly similar to the decidua reflexa, which attaches the ovum 
to the side of the womb ; this has been termed the decidua 
scrotina. I believe there can be little doubt but that the floc- 
culent exudation of the mucous membrane of the impregnated 
womb is a true secretion ; but whatever may be the origin of 
the decidua, whether it is an excretion of coagulable lymph, 
or a hypertrophy of the mucous membrane of the womb or 



40 GESTATION. 

a secretion from the blood it is very certain that, during the* 
formation of the decidua reflexa, both the ovum and the body 
of the womb become much enlarged; but all the decidua ex- 
cept the portion to which the ovum first becomes attached, af- 
ter the third month, becomes gradually thinner and glandular 
in appearance. The decidua of the womb remains quite thick, 
particularly around the plecenta up to the full term ef gesta- 
tion ; the decidua is then very thin, though about the third or 
fourth month they touch and press upon each other, yet need 
seldom be confounded. There is a difference of opinion on 
the part of physiologists as to the use of the decidua ; it is the 
opinion of some that it is to retain the impregnated ovum at a 
particular spot of the cavity of the womb, and others believe 
that it does not belong to the ovum, because existing as they 
think wherever there is an extra uterine pregnancy ; others 
suppose that it may be found in cases of tubal gestation * that 
one is secreted after each coition ; that it is formed at every 
menstrual period ; and manority, that it is not found in every 
case of extra-uterine pregnancy. There are some physiologists, 
of no mean authority, who discard the doctrine that the decid- 
ua is a new formation. With that authority I entirely agree. 
The only modifications that the womb really undergoes during 
the process of gestation, is a turgescense or erethism of uterine 
tissue, and a thickening of its mucous membrane, together 
with a profuse development of its gland. In the normal state,, 
neither the opening of the neck of the uterus nor the fallopian 
tube, is closed by membrane, but being full and permeable, 
allow the ovum to pass into the cavity of the womb, where it is 
arrested by folds of mucous membrane. 

The opinion of recent and eminent authorities is that the de- 
cidual membrane possesses the function of supplying the fecun- 



GESTATION. 41 

dated ovuru with the necessary material for its nourishment. 
This view is confirmed by its structure and time of develop- 
ment. 

THE DEVELOPMENT OF THE MUCOUS MEMBRANE. 

It is quite interesting to study the various stages of develop- 
ment of the mucous membrane during the process of gestation, 
for it indicates a rich provision for the nourishment of the new 
being during the various stages of its growth. At first we ob- 
serve that it has uniformly increased in thickness ; then a por- 
tion of it grows upward around the egg, covering its project- 
ing surface ; afterward the whole of the decidua vera becomes 
less active in their growth, and are now inconsiderable as a 
means of nourishment of the egg ; but the portion that is in 
contact with the chorion still continues to grow, becomes high- 
ly developed and prominently conduces to the formation of the 
after-birth. 

A rapid development takes place in the mucous membrane 
of the womb at the point where the ovum becomes arrested ; 
projecting folds sprout up around the ovum in such a manner 
as to inclose it and shut it off from the general cavity of the 
womb. Thus it is contained in a special cavity of its own, 
which still communicates, for a time with the general cavity, 
by a small opening, situated over its most prominent portion. 
As the growth of the mucous membrane around the ovum ad- 
vances, this opening becomes smaller, and finally, the ju-oject- 
ing folds of mucous membrane unite in forming a cicatrix to 
indicate, for a time, the spot of the original opening. The 
ovum has now a distinct cavity, a complete covering of its own. 
The ovum is received into the fallopian tube on leaving the 
ovary, it is transmitted by muscular motion, ciliary move- 



42 GESTATION. 

ments of the villi of the mucous membrane. The exact peri- 
od at which the ovum arrives in the uterus cannot be ascer- 
tained. 

As soon as the ovum arrives in the womb, it consists of two 
membranes : — First, chorion ; second, amnion. 

But in addition to the foregoing, we have three other fetal 
dependencies — the plecenta, a vascular and spongy body, cov- 
ering about a fourth of the ovule, and connects it with the womb r 
and lies external to the chorion; the umbilical cord, com- 
posed of the blood vessels which maintain the circulation be- 
tween the plecenta and child, and the umbilical and allantoid 
vescicle. The structure of the chorion is principally cellular y 
strongest in earty ova. It is covered externally by decidua 
reflexa, and is separated internally from the amnion by a layer 
of glutinous matter. The question as to where the ovum 
receives its external coat is much disputed. The opinion en- 
tertained by some is, that, it is when the ovum passes ^ilong 
the fallopian tube ;' others say, it is formed in the ovary ; and 
there are a great many who contend that it is formed in the- 
womb. This last opinion is the most generally entertained one. 
The inner surface of the chorion is lined by the amnion which 
contains the child and is filled with a serous fluid. At the 
commencement of the existence of the fetus or new being, it 
only adheres to the chorion at a single point, which corresponds 
to the abdomen of the child ; otherwise the two membranes are 
separated by false liquor amnii or serous fluid. The mem- 
branes after a while unite. As pregnancy advances, this mem- 
brane becomes thicker, and before delivery, becomes tougher 
and more tenacious then the chorion. The umbilicus of the 
child, the umbilical cord, and the fetal surface, are all cover- 
ed both with the chorion and amnion. The liquor amnii is- 



DEVELOPMENT OF THE NEW BEING. 43 

transparent in early fetal life, but at an advanced stage of preg- 
nancy, the flocculi of an albuminous substance give it a milky 
appearance. It is of a saline taste, a spermadic odor, and a 
viscid glutinous consistence. 

Traces of albumen, chloride of sodium, soda, lime and phos- 
phate of lime, with water compose its constituents. 

The quantity of fluid contained in the amnion is in contrary 
ratio to the size of the new being. 

There has been no satisfactory explanation made as to the 
source of this fluid. It is ascribed to the mother by some, and to 
the child by others. The quantity of this fluid varies from a 
few ounces to many pounds. The chorion and amnion are both 
subject to inflammation and the consequences of such a state. 



CHAPTER IX. 
DEVELOPMENT OF THE NEW BEING. 

A few days after impregnation has occur ed, the weight of 
the embryo is, as near as can be ascertained, about one grain, 
and its length about the twelfth of an inch. About the third 
week its shape and size have often been compared to a large 
ant or grain of barley. On the thirteenth day the situation of 
the upper and lower extremities become visible ; the length has 
increased to one third of an inch, and the rudiments of the prin- 
cipal organs are perceptible. 

About the sixth week, the shape of the child may be recog- 
nized, when it ceases to be called an embryo, and receives the 
name of fetus. Some, however, do not apply the term fetus to 
the embryo until the beginning of the fourth month, at which 



44 DEVELOPMENT OF THE NEW BEING. 

time its motions are discovered by the mother ; or, in other 
words the period of quickening. 

At the sixth week the head is larger in proportion to the 
rest of the body ; the trunk is elongated and pointed ; the limbs 
resemble the shoots of vegetables ; the eyes, mouth and nose 
are indicated by dark points, and parallel points indicate the 
vertebra. It is about an inch in length. 

In the second month nearly all of the parts are apparent. 
The eyelids are well denned and very transparent ; the nose 
projects, the mouth enlarges and opens, the fingers and toes 
are distinct. 

In the third month the eye lids are more developed and firm- 
ly closed ; an opening in the pavilion of the ear indicates the 
meatus and itoreus ; the sides of the ear are distinguishable ; 
the lips are distinct, and the mouth closed. During this month 
the genital organs are rapidly developed. The penis is long ; 
the scrotum often contains a little water, but the testes are ab- 
sent. 

The vulva is apparent and the clitoris very prominent. The 
brain is considerably developed, though still pulpy, as is the 
spinal cord. The lungs are insignificant, but the liver is large. 
The hearts action is detected. The upper and lower limbs are 
fully developed. The fetus is now three and a half inches long, 
and weighs two and a half ounces. 

During the fourth month the head and the liver increase less 
in proportion than the other parts ; the muscular system be- 
comes distinct, and slight movements are manifested. At the 
end of four months and a half the length of the child has in- 
creased to five or six inches, and weighs from four to five oun- 
ces. 

During the fifth month the muscular system becomes well 



DEVELOPMENT OF THE NEW BEING. 45 

marked, and the movements of the child are active and unmis- 
takable. The head is still disproportionally large, and begins 
to be covered with small silvery hairs. It is from seven to 
nine inches long ; weighs from six to eight ounces. 

In the sixth month the skin begins to be distinguishable from 
the epidermis or cuticle. The skin is of a purple color, smooth 
and delicate, and owing to the absence of adipose matter in the 
subcutaneous areolar tissue, seems plaited or wrinkeled. The 
scrotum is small and of a deep red color ; the vulva prominent, 
its lips separated, and the clitoris projecting ; the nails are form- 
ed. It is from ten to twelve inches long, and weighs about 
two pounds. A child born at this age usually breathes and 
cries a short time, but are seldom capable of living. 

During the seventh month all parts of the body almost at- 
tain their permanent proportions. The head occupies the low- 
er portion of the cavity of the womb, and is directed toward 
its mouth. The eyelids begin to separate, and membrana pu- 
pilares, which previously closed the pupil, begins to disappear ; 
the whole form becomes round and plump ; the skin is red, its 
sebaceous follicles excrete a white cheesy substance. 

At seven months the length is about fourteen inches, and 
weighs about three or four pounds. 

In the eighth month the child developes proportionally more 
in breadth than in length, and at this period is considered cap- 
able of maintaining an independent existence. The testicles 
which were formed within the abdominal paricles> descend into 
the scrotum ; the ossification of the bones of the skull, ribs and 
limbs is almost completed ; the nails are also completely form- 
ed. In length it is about sixteen inches ; and in weight over 
four pounds. 

At the end of nine months the length of the child is com- 



46 



DEVELOPMENT OF THE NEW BEING. 



monly from eighteen to twenty inches, and the average weight 
six to eight pounds. It is then fully matured. The full term 
is generally reckoned at about two hundred and eighty £days. 




THE FULL TERM. 

In numerous cases the measurement and weight greatly ex- 
ceed the above calculations. There have been cases in which 
the child has measured twenty four inches in length and weigh- 
ed from ten to sixteen pounds. 

THE CAUSES OF THE POSITION OF THE CHILD. 

The causes of the position of the fetus in the womb, during 
the various stages of gestation, is not understood, but it is at 
least certain that, by some vital act whether gravitation or not, 
the position of the head is downward, which is the only usual 
and strictly normal position best adapted to delivery. The 



DEVELOPMENT OF THE NEW BEING. 47 

body is bent forward, the chin resting upon the breast ; the 
head toward the brim of the pelvis ; one or both arms lying up- 
on the face, and both approximated in front; the thighs flexed 
upon the abdomen ; the knees apart, the whole body forming 
an oval whose long diameter is about ten inches. 

OME FACTS CONNECTED WITH THE CHILD IN 
UTERO. 

There are some facts connected with the child in utero that 
are highly interesting and instructive. The head is propor- 
tionally large, and the bones, having a membranous union, 
they can approach and even overlap each other, which circum- 
stance facilitates delivery ; and the unossified portions aiford a 
clue as to the nature of the presentation of the head ; they con- 
stituting the various fontanelles, so well known to the skillful 
accoucher. The thymus gland is very peculiar to fetal life 
and to infancy; it can rarely be seen in old age. This gland 
is one of the most obscure, in its physiology, of any organ in 
the body. The same may be said almost, of the thyroid gland. 
The lungs are dense and collapsed ; possess a dark, liver col- 
or ; do not nearly fill the chest, and having a specific gravity " 
greater than that of water, instantly sink when introduced in- 
to that fluid. The weight of the lungs of a full grown fetus is 
about one seventeenth of the entire body. The liver at birth 
is remarkably large, but it soon diminishes after the birth of 
the child. 

The bladder is large, and is endowed with greater propor- 
tionate power than in the adult. 

The sexual organs cannot be observed before the sixth week, 
at which time the rudiments of the scrotum or vulva appear ; 



48 DEVELOPMENT OF THE NEW BEING. 

very soon, an aperture can be recognized, which is related both 
to the genital organs and anus. A tubercle is in front of this 
aperture, which in course of a week or two, exhibits a gland and 
underneath a channel is grooved extending to the anus. About 
the expiration of the third month the perineum distinctly ap- 
pears ; but not till about two weeks afterwards, does the sex 
become apparent. 

WHAT DETERMINES THE SEX? 

This doctrine can only be described hypothetically. For 
it is the hypothesis of some that every embryo is originally fe- 
male, and, if its growth should be any way arrested, it remains 
such. It is supposed to constitute the male ; that the vul- 
va is united to form a raphe ; that the clitoris is elongated in- 
to a penis ; labia majora unite to become the scrotum, as the 
nymphae do to form the urethea. Others entertain the doc- 
trine that the original sex is masculine, and others that at first 
it is neutral, and that the sex is decided by merely accidental 
circumstances, relating to time of conception, or the early per- 
iod of fetal life. 

Whether the theory be true, that all the children of a cer- 
tain sex, are those whose conception has occur ed in the first 
half of the time between menstrual peridds and producing fe- 
male offspring, or male in the later half, we are not able to say. 

Some of the most eminent physiologists have attributed the 
difference of sex to the greater vitality of either parent. 
While it is no doubt true, that the greater constitutional en- 
ergy of one parent will materially modify the child, whether 
male or female, yet we do not believe it can determine the 
sex. 



THE PLECENTA OR AFTER-BIRTH, ETC. 49 

We can not decide as to the truthfulness of the late German 
theory that : "The organs of the right side, respectively, of the 
male and female pertain to the male sex, and the organs of 
the left side, to the female sex. That is to say, the right tes- 
ticle produces sperm cells, and the right ovary of the female 
germ cells, whilst the left testicle produces female sperm cells, 
and the left ovary female germ cells. The semen of each can 
only impregnate the ovum of the corresponding ovary." 

We are disposed to think that this theory is the most plaus- 
ible, as it is the most consistent with known facts, if it does not 
afford us the key to unlock the mystery, as many experiments 
have been conducted that the important and difficult subject 
might be elucidated. 



CHAPTER x. 

THE PLECENTA OR AFTER-BIRTH ; FE- 
TAL CIRCULATION ; ARATION OF 
BLOOD IN THE AFTER-BIRTH. 

The plecenta is a soft spongy, somewhat flat and vascular 
organ ; it is of a circular or oval shape. In diameter, it is 
from six to eight inches, and in thickness at its centre, an inch 
to an inch and a half, becoming gradually thinner towards the 
circumference. In weight it averages about one pound. Its 
two surfaces are respectively called fetal and uterine surfaces, 
as internal and external ; the fetal surface is smooth and shin- 
ing from the fact that it is covered by the chorion and amnion, 
beneath which may be observed the radiations of the umbilical 



50 



THE PLECENTA OR AFTER-BIRTH, ETC. 



vessels. The uterine surface is uniform and level, but not en^ 
tirely smooth, as it is covered with the decidua scrotina. This 
after-birth is developed by the chorion, on that part which is 
in contact with the womb. 




THE PLECENTA. 

This organ forms a medium of communication between the 
mother and child, its function being*, to supply nourishment to 
the child. From the distribution of the umbilical arteries and 
veins over its surface, the fetal surface presents an aborescent 
appearance. The question as to whether there be a direct vas- 
cular communication between the plecenta and womb, was form- 
erly much disputed. Now, as a result of modern research, that 
doctrine is not generally embraced. When considered physi- 
ologically, the after-birth consists of two distinct parts — the cir- 
culation of the one, being distinct from the other, for the blood 
vessels of the maternal portion are not continuous with those of 
the fetal portion. The utero-plecental vessels maintain the 
circulation on the maternal surface ; the umbilical cord con- 



THE TLECENTA OR AFTER-BIRTH, ETC. 51 

sists of vessels that supply the fetal surface. The blood of the 
parent differs from that of the child in utero in the size and 
number of its red corpuscles, and in the relative amount of fi- 
brine and albumen that it contains. 

About the second month of pregnancy, not before, the after- 
birth begins to form. It is liable to malformations, displace- 
ments ; hypertrophy or atrophy may take place ; it is the seat 
of cartilaginous or calcareous degeneration, and is liable to 
inflammation and its consequences. 

The bond of union between the child and after-birth, is the 
umbilical cord, funis or navel string. It is composed of two 
arteries and one vein, and, though its length varies very much 
in different fetuses, it generally is about the same length as the 
child throughout the whole course of its development. The 
arteries convey the impure blood of the child to the plecentaor 
after-birth, and the vein conducts the arterial blood from the 
plecenta to the child. It is visible at the earliest period of 
pregnancy, and generally arises from the centre of the plecen- 
ta. At first the cord is thin and cylindrical, but from the 
fourth to the ninth week, it presents two or three vascular 
swellings, which finally disappear. 

The vessels now run into a spiral form — the arteries around 
the vein from left to right. 

The vein has no valves, and is equal in calibre to that of both 
arteries. The pulsation of its arteries is dependent on the 
heart's action. In fifteen or twenty minutes after the birth of 
the child, this pulsation ceases, and the umbilical portion of 
the cord dies, withers and usually falls off not later then a 
week after birth. 



52 THE PLECENTA OR AFTER-BIRTH, ETC. 

FETAL CIRCULATION. 

The arterial blood for the nourishment of the child is carried 
from the after-birth by the umbilical vein, along the free mar- 
gin of the suspensory ligament of the liver to the under sur- 
face, where it gives off several branches to the left lobe. It 
divides at the transverse fissure into two branches ; one of these 
is joined by the fetal vein and enters the right lobe ; the other 
branch continues onward as the ductus venosus, and joins with 
the inferior vena cava. The greater portion of the blood cir- 
culates through the liver with the portal venous blood before 
entering the cava by the hapatic veins ; some enters the liver 
directly ; and a small quantity passes directly into the veno 
cava, by the junction of the ductus venosus, with the left he- 
patic vein, the blood of the inferior cava becomes mixed with 
that returning from the lower extremities and abdominal vis- 
cera. It enters the right auricle, and, guided by the eustach- 
ian valve, passes through the foramen ovale into the left aur- 
icle, where it becomes mixed with a small portion of blood, 
returned from the lungs by the pulmonary veins. From the 
left auricle it passes into the left ventricle into the aorta, from 
whence it is distributed almost entirely to the head and upper 
extremities. From the head and upper extremities the blood 
is returned by the branches of the superior vena cava to the 
right auricle. From the right auricle it descends over the eu- 
stachian valve into the right ventricle, and from the right 
ventricle, into the pulmonary artery. The lungs of the fetus 
are nearly impervious ; only a small portion of the blood is dis- 
tributed to them by the right and left pulmonary arteries ; this 
is returned by the pulmonary veins to the left auricle ; the 
greater part passes through the ductus arteriosus into the 



THE PLECENTA OR AFTER-BIRTH, ETC. 53 

commencement of the descending aorta, when it becomes mix- 
^d with a small quantity of blood transmitted by the left ven- 
tricle into the aorta. It descends along this vessel to supply 
the lower extremities and viscera of the abdomen and pelvis, 
but the greater portion being, however, conveyed by the um- 
bilical arteries to the after-birth. 

ARATION OF BLOOD IN THE AFTER-BIRTH. 

The after-birth is the lungs of the child in utero. It rep- 
resents the digestive as well as the respiratory organs of 
the adult. All throughout fetal life the decarbonization of the 
blood is accomplished in the after-birth. The impure blood is 
conducted from the child to the plecenta, through the umbili- 
cal arteries. The umbilical arteries ramify and anastomose 
with the radicals of the umbilical vein on the fetal surface. 

As in the lungs of the adult, the blood expels its carbonic 
acid gas, and draws oxygen from the atmosphere; so the same 
process is carried on in the plecenta of the fetus. 

The effete material passes into the vessels of the mother, but 
she only supplies the arterial blood, so requisite for the sus- 
tenance and growth of the child. 

We can easily infer, from the existence of remarkably close 
connection between the mother and the child, that if the moth- 
er does not breathe sufficiently, the child must also suffer. A 
great many mothers of vigorous constitutions, have given birth 
to children that were so delicate and scrofulous, that they did 
not survive to adult age. What reason can be assigned for 
this ? In very many cases, simply, because during the period 
of gestation the mother was too sedentary and plethoric ; 01% 
more frequently because, during gestation, her respiratory fjs- 



54 SIGNS OF PREGNANCY. 

tem had become seriously obstructed. She may have breathed 
sufficiently to have kept up her own system, but has not inhal- - 
ed sufficient oxygen, for the support of the intro-uterine well 
being as well. 

Still-births are often to be accounted for on this principle. 



CHAPTER XI. 

SIGNS OF PREGNANCY. 

In order that the function of generation may be accomplish- 
ed there must be a concurrence of the two different systems of 
genital organs, the one being the female yielding an ovum, the 
other a male yielding spermatazoa. There is involved in the 
act of generation, the union of the contents of two peculiar 
cells — the female germ cell, and the male sperm cell. The 
germ cell being vivified by the sperm cell, gives vitality origin 
and immortality to a new being; the embryo, if supplied with 
nourishment, heat, fixation, gradually evolves itself into the 
likeness of its parents. The germ cell or ovum, when dis- 
charged from the ovary, has all the elements of vitality although 
not generally alive ; fecundation imparts to it generic force — 
endows it with powers of growth. 

Pregnancy is the retention and development of fecundated 
ovum in some of the uterine organs, until it is capable of inde- 
pendent existence, and expelled by an act of parturition. It 
is very important that we should have some unequivocal signs 
of the existence of pregnancy ; indeed, it is highly important 
that the pregnant and non-pregnant condition should be posi- 
tively determined. Many times the physician is called upon 



SIGNS OF PREGNANCY 55 

to pronounce upon a case of supposed pregnancy which is a 
very embarrassing position ; for upon his decision, frequently 
hangs the destiny of the happiest and brightest woman that 
ever lived. He should be extremely cautious before he lets 
his opinion fall from his lips. He should always remember 
that the fair fame of woman is like the delicate impalpable 
powder upon the beauteous wing of the butterfly, once brushed 
off, it never can return, and the verdict, too hastily given, can 
never shine forth again in its pristine brightness and purity. 

Now if woman had a proper knowledge of the signs of preg- 
nancy, it would be of great value to herself, as well as great 
assistance to the physician. 

The signs of pregnancy have been divided into two kinds. 

First, rational : second, sensible. 

RATIONAL SIGNS. 

Under this head we would mention the general effects on the 
system ; frequency of the pulse ; increased plasticity of the 
blood ; disturbed respiration ; the greater activity of the se- 
cretions ; abnormal condition of the nervous system, 

From these symptoms, however, we can draw no valid infer- 
ence, and they are only valuable when taken in connection with 
the following, which are of a more positive nature. 

After coition has occured, if the semen is retained, it is an 
evidence of its success. The following day the eyes are sur- 
rounded by a bluish circle, a slight fullness of the neck, and a 
general erethism of the system. 

The suppression of the menses is the first probable symptom. 
Females cease to be regular during pregnancy ; but there are 
cases of menorrhagia frequently met with dependent upon ex- 
citement or congestion, occuring in the womb as a result of too 



56 SIGNS OF PREGNANCY. 

frequent copulation and other causes. The suppression of the 
menstrual discharge is, however, a well marked sign, though 
it is merely a presumtive one. It must be taken in connec- 
tion with other symptoms. In many cases the monthly dis- 
charge does not make its appearance, having been suppressed 
by some other cause than pregnancy. Cold is a very common 
cause of suppression. And the greatest caution should be ex- 
ercised in forming and expressing an opinion on this point in 
the case of many ladies, particularly the unmarried. 

Even suppression accompanied with increased volume of the 
abdomen, is not always to be depended on, as the enlargement 
of the abdomen may result from so many different causes. 

There are, however, peculiarities in the shape and mode of 
development of the abdomen in gestation, aside from other 
causes — the rotundity and gradual enlargement. 

A depression of the umbilicus takes place early in pregnan- 
cy. The umbilicus is thrown downwards and backwards, in 
consequence of the tension of the urachus occasioned by the 
descent of the womb. But, about the third month, the womb 
gets above the superior strait, and the umbilicus resumes its 
natural condition ; but about the fourth month it is less hollow, 
and after awhile its bottom, becomes more superficial, and by 
the sixth month the depression is entirely gone, and during the 
last two months, the navel forms a prominence. 

These changes are invariably present in pregnancy, and 
therefore afford a rational sign of great value. These altera- 
tions in the region of the navel may be produced by a tumor of 
considerable size, and also by an accumulation of fluid in the 
peritoneum ; but it is nevertheless true that they are always 
present in pregnancy. 



SIGNS OF PREGNANCY. 57 

In the primiparous female the presence of a brown line be- 
tween the pubis and umbilicus is a very important sign. 

There are changes that take place in the mamma, which 
changes are a positive sign of pregnancy. Shortly after preg- 
nancy has commenced, the color of the areola will be changed 
from a pinkish hue to a deep brown. This change in color is 
more marked in first pregnancies and brunettes. 

Besides this discoloration of the areola, the sebaceous glands, 
seated under the skin of the areola, becomes enlarged, which 
causes a rough uneven appearance. The breasts enlarge 
about the second month, the nipples project, become erect and 
assume a brownish color. 

Alterations take place in the urine of the pregnant, which 
are peculiar to that state. It has been the opinion of some that 
pregnancy can be detected by a microscopical and chemical ex- 
amination of the urine without resorting to the usual means of 
ascertaining this fact. 

As for myself, I am inclined to differ with that view of the 
subject, although I attach a good deal of importance to these 
signs. 

Nausea and vomiting have been considered a very import- 
ant sign, though this symptom would not justify a positive as- 
sertion. Taken, however, in conjunction with other symptoms, 
nausea and morning sickness are of great utility in enabling 
one to come to an affirmative conclusion, 

These generally arise immediately upon getting out of bed in 
the morning and often give rise to a great deal of distress, and 
the vomiting is at times so aggravated as to endanger a mis- 
carriage from the violence of the straining. Nausea and vomit- 
ing of pregnancy are sympathetic in their nature. Certain im- 
portant changes are going on in the economy and there is an 



58 SIGNS OF PREGNANCY. 

unusual amount of tax upon the nervous system. The stom- 
ach being the first to take up sympathy, it gives expression 
thereto by nausea and vomiting. The condition of the ap- 
petite taken in connection with other signs, is not to be over- 
looked. A woman in a state of pregnancy has a capricious 
and deprived appetite. She is very fickle, irregular and change- 
able in regard to her eating. 

SENSIBLE SIGNS. 

These signs are of greater utility to the physician than to 
the female herself because they come particularly under his ex- 
amination and observation, and aid him in forming his diagno- 
sis. Indeed it were impossible for the patient to observe at 
least some of the signs to which we are about to refer. Then 
again others are noticeable by her and when once observed set- 
tle the question as to whether she is pregnant or not. 

There are certain changes that occur in the neck of the 
womb, which can only be observed by the touch. It requires 
a second party to do this, and of course the physician is the 
proper one. Before impregnation the neck of the womb is an- 
alogous to that of fibrious tissue, but after conception it be- 
comes softer, gradually extending from the neck upwards so that 
by the sixth month, one half of the neck has undergone this 
change. During the la«t three months the whole of the neck 
becomes softened. This process of softening is not quite so 
rapid in the primiparae as in the multiparae. As this soften- 
ing advances, the cavity of the cervix dilates. The external 
orifice of the neck in the primiparae remains closed till near 
the end of gestation ; in the multiparae, increasing in pro- 
portion to the number of pregnancies ; it is patulous and in 
some cases, sufficiently so to admit the finger. 



SIGNS OF PREGNANCY. 59 

The situation of the neck of the womb in the various periods 
of pregnancy is of considerable value. We have seen in anoth- 
er part of this work that it is lower in the vagina, and is thrown 
more upwards under the symphysis pubis ; after this the womb 
rises up in the pelvis and the vagina with it and then the neck 
is thrown toward the curvature of the sacrum ; and in the last 
month of gestation, the os uteri is directed toward the hollow of 
the sacrum. 

And, then, we have palpation of the abdomen, a means 
which the physician employs in addition to those already men- * 
tioned, and upon which he places a great deal of importance. 
The womb assumes different positions in the respective months 
of pregnancy. 

Let us take the first three months of pregnancy, and we find 
that the uterus remains entirely in the lower pelvis or else its 
fundus projects above the superior strait, and is usually easi- 
ly discovered by the feel of a soft movable tumor, with a smooth 
and regular external surface. 

During the menstrual periods the womb becomes congested 
and tumefied, and this condition is apt to be confounded with 
pregnancy, and more particularly, because, at those epochs, 
the neck generally becomes softer and dilates some. But, af- 
ter all, there is no positive sign of pregnancy during the first 
three or four months, but when the sensible signs agree with 
the presence of the rational ones, in a healthy woman, who has 
no intention to deceive ; yet in a legal case, I should as a phy- 
sician be very careful in expressing my opinion and should 
be disposed to express my doubts, until haying made an ex- 
amination at an advanced stage of the supposed pregnancy. 

But during the last five months, the existence of pregnancy 
is announced by certain signs that are more reliable than any 



60 SIGNS OF PREGNANCY. 

of those we have previously mentioned; indeed they are un- 
mistakable in their character. They are revealed both by 
sensible and physical signs of the greatest value. There is no 
symptom more to be depended upon than quickening. This is 
experienced by a fluttering movement, produced by the child, 
and usually takes place about the end of the fourth month. 
The strength and frequency of these movements are governed 
by the character of the child. But even this symptom is cal- 
culated to deceive, as a sensation similar to this is produced by 
ascites, excited peristaltic action, rapid passage of flatus, irreg- 
ular contractions of the abdominal muscles, aneurism or pul- 
sation of the discending aorta. And there are some women, 
who, when they intend to deceive, have an art of causing con- 
traction of the muscles of the abdomen. 

The movements of the child are a sure sign of pregnancy ; 
although these movements may not be felt, yet it is no evidence 
that pregnancy does not exist, as the child may be dead, or of 
very feeble vitality. 

Quickening usually occurs at about the end of four or four 
months and a half. 

The pulsation of the fetal heart, is a positive sign of preg- 
nancy. These pulsations are to be recognized in the last half 
of gestation. Two sounds are observed, very distinct in char- 
acter, which are produced by the movements of the child's 
heart, and may be compared to the ticking of a watch wrapp- 
ed in a towel. 

The pulsation of the child's heart in utero, are more frequent 
than those of the mother's heart. They range from one hund- 
red and thirty to one hundred and sixty per minute, and are in- 
creased or diminished without being able to detect the cause. 



DURATION OF PREGNANCY, ETC. 61 

By this means the physician is able to discover twin pregnancy, 
and life or death of the child 

Let us recapitulate the signs of pregnancy : suppression of 
the menses, nausea and vomiting, capricious or deprived 
appetite, salivation, enlargement of the breasts and abdomen, 
nervousness, quickening, flesh color around the areola of the 
nipple, lassitude, etc. 

The following conditions, to a greater or less extent, accom- 
panying a state of pregnancy : headache with plethora, tooth- 
ache, heartburn, longings, hysteria, constipation, diarrhoea, 
gastrodynia, palpitation of the heart, dyspnea, mastodynia, 
muscular pains, suppression of the urine, varicose condition of 
the veins of the legs. 



CHAPTER XII. 

DURATION OP PREGNANCY AND THE 
VIABILITY OP THE CHILD. 

In the most of cases, the period of human utero gestation is 
nine calendar months. Two hundred and eighty days is the 
average result. There is quite a difference of opinion with re- 
gard to the time of the limit of the deviations from this period ; 
yet a certain latitude has been allowed in all legal points. There 
are many cases on record where gestation has been continued 
for weeks behind the usual time. This difference, however, 
may have resulted, to some extent, from the difficulty of fixing 
the precise time of conception. How much beyond the usual 
normal period of pregnancy it may extend, it is impossible to d - 
termine in a given case ; we can safely state, however, that it 

6 



62 STERILITY. 

can not exceed ten months. The evidence is clear and em- 
phatic, that a protraction over nine months is all that is neces- 
sary. In case conception takes place immediately after the 
menses, this would account for a variation of a month. 

The legitimacy of a child born three hundred days after the 
dissolution of marriage, according to the French code may be 
contested. In one of our neighboring states there are two 
cases of gestation recorded, the one of which was protracted to 
three hundred and thirteen days, and the other to three hund- 
red and seventeen days, and both were admitted by the court 
as legitimate. This is a question, however, that legal action 
is not able to settle, and one, in my opinion that never can be 
settled. 

VIABILITY OF THE CHILD. 

The question as to when the new being is capable of carry- 
ing on an independent existence is quite as hard to solve as 
the previous one. At the end of the seventh month is the 
time generally fixed. As a general thing this is correct, but 
there are some exceptions to this rule. There are some cases 
for which there is good authority, where children have been 
born during the sixth month, and have lived for months and 
years. 

CHAPTER XIII. 

STERILITY. 

By sterility is meant an inability to conceive. This is found 
to be the case with many patients. The causes of this condi- 
tion are divided into functional or organic, curable or incurable, 
into pure sterility or impotency. As one of the organic causes 



STERILITY. 63 

of sterility, we would mention the absence of the ovaries. 
This is a very frequent cause, and such a condition will render 
the patient incurable. But, say the ovaries are present, they 
may be diseased as is often the case ; there may be a scirrhus 
condition, or the Graafian vesicle may be consequently defi- 
cient or diseased, and of course conception could not take place 
under such circumstances. 

Imperforation, deficiency, obliteration from inflammation or 
exudations may be the cause of sterility, by preventing the 
spermatozoa from reaching the ova. In some cases the womb 
may be absent ; or if it be present the cavity may be either 
partially or entirely obliterated. In some instances the canal 
of the neck has been impervious and the mouth closed or cov- 
ered with membrane, thus causing sterility. Another cause of 
this difficulty is the absence of the vagina. But it is the opin- 
ion of a good many that the most common cause of sterility is 
the marriage of parties whose temperaments do not suit each 
other, being too near alike, the unsuitable marriage of blood 
relations, and the disparity of age and constitutions. But, in 
addition to these as well as many other organic causes, we have 
the functional, which are generally curable. The organs inter- 
nal and external may lose their sensibility to pleasure, these 
may merely be the cold indifferent, or even painful or repulsive 
reception of the masculine embrace, and still the ovaries may 
form their germs, but from some incompatibility, there is no 
production. Inflammation of the womb, fallopian tubes, or 
ovaries may be the cause of sterility. In very Kiany women 
where there is lucorrhoea, the condition and quality of the dis- 
charge may produce sterility. And an acid vaginal mucous 
has a tendency to produce the same effect as the live sperma- 
tozoa are destroyed by coming in contact with acid mucous. 



64 SPURIOUS PREGNANCY. 

We may enumerate among the curable causes of sterility, 
congestion, ulceration, which are the consequences of inflam- 
mation. 



CHAPTER XIV. 
SPURIOUS PREGNANCY. 

Spurious pregnancy has been divided into two varieties : 

1. A Local. 

2. A Constitutional. 

THE LOCAL. 

This variety we observe frequently in dysmenorrhoea, where 
the patient, every month has excessive development of the 
mucous membrane, which is formed in the early weeks of real 
pregnancy. The patient in such cases endures a great amount 
of suffering during the expulsion of these exudations, and often 
some of the constitutional and sympathetic phenomena of preg- 
nancy exhibit themselves, such as, morning sickness, vomit- 
ing, enlarged breasts, the areola around the nipple darkened. 
The most distressing symptoms are those of the womb. 

THE CONSTITUTIONAL OR SYMPATHETIC. 

In this form of spurious pregnancy we have presented the 
symptoms of genuine pregnancy as follows : nausea, vomiting, 
enlarged breasts, darkened areola, secretion of milk, enlarged 
abdomen, and movements are felt, which the patient pronoun- 
ces a child, menstruation is suppressed, and these symptoms 



SPURIOUS PREGNANCY. 65 

may continue, progressively, the woman laboring under a delu- 
sion that she is really and truly pregnant ; and it may be that 
labor apparently will set in and the true condition may not be 
discovered until the physician is called in; cases of this kind, 
however, do not often occur. 

One physician of a large practice, says, as his experience out 
of four thousand cases, he has known but about sixteen of the 
kind under consideration. Spurious pregnancy is not confined 
to the married, but it happens frequently with the single, usu- 
ally occuring in patients from thirty five to forty five years of 
age, but in some few cases the patients are somewhat under 
this age. It is often very hard to distinguish between the 
false and the true pregnancy, as the identical symptoms are 
met with in both. And of course it requires the skill of the 
physician to make such a distinction. Spurious pregnancy 
does not always run a definite course and the period of exis- 
tence differs in different persons. All of a sudden there may 
be a cessation or abortion of the disease, after the symptoms 
have all been fully established, and have gone on uninterrupt- 
edly for weeks or months. 

In some other cases the symptoms may continue for nine 
months, and the woman kept under delusions, till the accom- 
plishment of the period of pregnancy, when the phenomena -of 
false pregnancy terminate with all the symptoms of labor, or 
it may be, without any assignable reason, some cases will 
continue for months and years. 

PATHOLOGY OF SPURIOUS PREGNANCY. 

This as it is supposed would seem to depend upon an in- 
flamed, hypertrophied, congested state of the womb, or upon 



(j6 SUPERFETATION. 

either anteversion or retroversion or ulceration, and other 
morbid conditions of that organ and the ovaries. It gen- 
erally depends upon some physiological change in the above 
named organs, without change or irritation. 

The sympathetic developments which are seen at one period, 
have not had sufficient time to subside before a stimulus is 
supplied for its continuation by the recurrence of the menstrual 
period. 



CHAPTER xv. 

SUPERFETATION. 

This term is applicable to those cases of abnormal concep- 
tion in which a female, already pregnant, has been supposed to 
conceive a second time before the accomplishment of the period 
of first pregnancy. The belief is general that such an occur- 
rence is possible. Itis frequently the case that after the birth of a 
living child at full time, a small ovum or dead embryo is thrown 
off, of an age much less than that of the perfect infant, such a 
circumstance has led many to the belief that superfetation may 
occur in the human subject, or that a second impregnation may 
happen in an already impregnated womb. Cases might be 
mentioned in which two connections, one a white and the oth- 
er a negro were both prolific, and considered as true instances of 
superfetation, but in such it may have been that the woman 
conceived the second time before the first ovum had entered 
the cavity of the womb ; decidua had formed before the gel- 
atine substance had plugged up the mouths and neck of the 
womb. It would be impossible, however while one fetus of 



SUPERFETATION. 67 

four, five, or six months growth occupies the womb, of a sub- 
sequent impregnation to take place. 

The theory of superfetation may be explained in the following 
way : namely, upon the supposition that the patient originally 
conceived twins ; that one of them lost its life early in pregnancy 
perhaps from certain causes operating upon the mother or from 
some defect in structure, or diseased condition ; and that the pro- 
cess of gestation was carried on for the benefit of the live fetus, 
till they were both expelled together, or nearly at the same 
time, at full period of pregnancy. The secondary fetus, is 
generally expelled from the womb, either with the plecenta of 
the living child, or soon afterwards. It is possible for a 
woman to be delivered of two living children at one birth ; the 
one being perfect, the other small and imperfectly developed. 

We have cases on record where the birth of the perfect child 
was followed after the lapse of some months by the birth of « 
another. Such cases would cause us to assume that a second 
impregnation may occur, although the womb may be occupied 
by the results of a previous conception. Frequently twins are 
conceived from one intercourse, and very often the one of them 
is blighted. Nothing, we think, is more common in twin preg- 
nancy, than to find one more fully grown than the other, and 
nothing more easily explained without resorting to the doctrine 
of superfetation. We admit that, where a double womb exists, 
an opportunity may be given for a double conception ; at the 
same time we do not believe that any single case will explain all 
that are on record. There are certain objections of a physical 
nature, that have to be set aside in order to accept fully the 
doctrine of superfetation. The objections referred to are as 
follows : the womb, after conception has taken place, is lined 
with the deciduous membrane, which is a stout sac, adhering 



68 EXTRA-UTERINE PREGNANCY. 

closely to the lining membrane of the uterus throughout, 
and covering the orifices of the mouth of the womb and of 
the fallopian tubes : during pregnancy the neck of the womb, 
is plugged with tenacious matter. 

If this be true, and it is necessary for the spermatozoa to 
enter the womb as an essential condition of generation, it is 
apparent that the theory of superfetation involves an impos- 
sibility. 

But we would remark, that it is not necessary for us to accept 
the doctrine of superfetation , in order to explain the birth of 
a mature fetus and blighted ovum ; of a mature and immature 
child born together, or a month of each other ; or of children 
of different colors, from the fact, that they may be the product 
of one or two acts of generation, nearly at the same time. 
That in case of double uterus, a second conception may possi- 
bly occur at a later period than the first. That where one 
mature child has succeeded the birth of another after a consid- 
erable interval of time. 

We have no evidence of double womb, but in one case, that 
has been recorded, we have positive proof that it was single. 
In the present state of our knowledge, there are insurmount- 
able difficulties, for our accounting for such cases on the super- 
fetation theory. 



CHAPTER xvi. 
EXTRA-UTERINE PREGNANCY. 

It occasionally happens, after impregnation has taken place 
that the ovum does not arrive in the womb, but remains imbed- 



EXTRA-UTERINE PREGNANCY. 69 

ed in the ovary or fallopian tube, or nil Is in the general cavity 
of the womb. In other words, when the Graafian vesicle bursts, 
instead of the ovum being seized by the fimbriated extremity 
of the fallopian tube and carried into the womb, it is arrested 
and attaches itself to that portion of the mother's body, where- 
ever it may have happened* to lodge, and a communication, by 
vessels, and attachments is quickly set up ; a plecenta is formed 
for the nutrition of the fetus. Often this is only partially suc- 
cessful, and if so, the child perishes for want of nourishment. 
The cause of this, however, is but partially understood. 

Different varieties of Extra-Uterine Pregnancy have been 
named by authors, and we shall name them in regular order. 

1. Ovarian Fetation. 

2. Tubular Fetation. 

3. Abdominal Fetation. 

4. Paerietal or Interstitial Fetation. 

OVARIAN :■ FETATION. 

This is when the ovum is detained in the ovary. This as a 
usual thing takes place, when the fimbriated extremity of the 
fallopian tube has embraced the ovarium and has impregnated 
the ovule without having detached it from its bed. It ad- 
heres, grows, and the ovarium is converted in£o a sac contain- 
ing a newly organized being. 

As far as the ovarian pregnancy is concerned, some writers 
regard its existence as doubtful. This doubt is entertained 
on the ground that great facility is offered for the escape of the 
ovum when the Graaffian vesicle has been ruptured. 

TUBULAR FETATION. 

This is when the fallopian tube is the place of arrest. In 
this variety, the fimbriated extremity of the fallopian tube has 



70 EXTRA-UTERINE PREGNANCY. 

grasped the ovarium detached an ovum and impregnated it, 
and the ovum in its transit through the tube becomes attached 
to the tube, developes and grows. 

ABDOMINAL FETATION. 

This is when the fimbriated extremity of the fallopian tube 
has seized the ovary, impregnated an ovule, but from some 
defect instead of retaining it within its grasp, has allowed it 
to fall into the general peritoneal cavity. 

PAERIETAL OR INTERSTITIAL FETATION. 

This is when the ovule, after having been impregnated, h&s 
passed through the fallopian tube, until it has reached that 
portion of the canal which traverses the structure of the womb, 
and has become imbedded there. A sac is formed into the 
parietes of the womb, caused by the growing ovum which lies 
within it, and as the living being continues to increase, this 
sac distends; so that the ovum is shut up in a cavity, formed by 
the walls of the womb and the womb would seem to be divi- 
ded into two portions, the one containing the cavity, the other 
this sac. 

The tubal is the most frequent, and parietal or intestinal, the 
most rare of the different varietes of extra uterine pregnancy. 

Just as soon as any variety of either of the irregular impreg- 
nations has occurred, notwithstanding the ovum is not .received 
into the womb, a determination of blood is made to the womb, 
by which its size is enlarged, as is the case in natural preg- 
nancy, and sometimes it acquires considerable bulk. The 
membrane is formed within its cavity, and the tenacious, gluti- 
nous mucus is secreted by the glands of its mouth, and neck, 
insufficient quantity to close the opening. 



EXTRA-UTERINE PREGNANCY. 71 

In some instances the ovum becomes fully matured ; it then 
dies and putrefies. Inflammation takes place in the sac in which 
it lies ; adhesion takes place between the sac and the adjacent 
parts of the rectum; ulceration follows, and finally the child 
in pieces escapes from the bowels. 

Some cases terminate by adhesion of the uterine and vesic- 
ular cavities, and the fetus destroyed by putrefaction, escapes 
externally. 

Again other cases, terminate by the child dying, and becom- 
ing converted into a substance resembling bony, earthy or 
semi-calcareous matter, and remains perfectly harmless through- 
out life. Nor does the presence of an extra uterine pregnancy 
prevent a future conception any more than the extirpation of 
an ovary. 

It is a circumstance worthy of note in the history of these 
extra-uterine pregnancies, that if the child lives until the ter- 
mination of gestation, the womb begins its expulsive efforts, 
as soon as the proper time arrives, which is attended with 
most all the symptoms of labor, expulsive pain and sanguin- 
eous discharge. Life is never continued to the child beyond 
the natural term of gestation. 

In case the conception should be tubal or parietal, it gener- 
ally is the case that the sac bursts long before the child has ar- 
rived to maturity, say about the third or fourth month, and it 
then escapes into the abdominal cavity, and the woman dies of 
internal hemorrhage. 

Then we have the natural terminations of extra-uterine 
pregnancy ; 1, the sac bursts; 2, the fetus dies and putrefies, 
and it may escape by ulceration ; 3, the fetus dies, and remains 
an innocent mass ; this we conceive to be the most innocent 
termination that could be wished for 



72 EXTRA-UTERINE PREGNANCY. 

CAUSES. 

It may be that either congenital malformation, or pathologi- 
cal changes retain the fecundated ovum in the ovary, or pre- 
vent its passage into the fallopian tube or arrest its progress 
after it has entered. 

Narrowness of the uterine orifice of the fallopian tube, or an 
unusual large interspace between the fibers, or a partially corn- 
nated womb, has been thought to occasion the interstitial 
variety of extra-uterine pregnancy. One writer explains thus : 
He is of the opinion that it is occasioned by a preternatural 
thickness of the covering of the ovule or envelope of the ovary, 
which may detain the ovum and prevent it from entering the 
fallopian tube; also other conditions, such as paralysis, spasms 
exercise, insufficient length, engorgement, contractions, or 
inflammation and ulceration of its mucous membrane. 

But a disturbed nervous system during the act of coition 
such as shock, surprise ouring the embrace, terror, fear has 
induced it. 

Unmarried females are often subjects of it when they become 
pregnant ; and also women who conceive by stealth or fear, or 
under great excitement. 

SYMPTOMS. 

At first the symptoms in extra-uterine pregnancy are very 
indefinite and obscure, but generally they are the same as those 
experienced in incipient pregnancy as follows : suppression of 
the menses, enlargement of the breasts, discoloration of the 
areola, morning sickness, more local pain is felt, pain gener- 
ally low down within one or the other of the ilia. It may 
depend on inflammation or the cyst not yielding kindly to the 
enlarging ovum. 



KXTRA-UTERINE PREGNANCY. 73 

In not a few cases the symptoms are so slight as not to elicit 
attention. In case the fetus continues to live it quickens, but 
the motion is felt mostly on one side; usually there is suffering. 

The patient increases in size, and sometimes it happens that 
the outlines can be traced through the parieties of the abdomen. 
In some cases the menses may occur, generally irregular, pro- 
fuse in quantity, and attended with shreds of coagulated fleshy 
substances. 

The physician on making an examination per vagina finds 
considerable deviation from the condition of the organ in ordi- 
nary gestation. The mouth of the womb may be high up or 
to some extent depressed. In case the cyst in which the ovum 
is contained bursts, a new series of alarming symptoms quick- 
ly follow. 

The woman complains of uneasiness, or pain suddenly occur- 
ing, languor, debility and exhaustion. In some cases there is 
a sanguineous discharge from the vagina, but absent in others. 

This state of things may last sometime, the mother moving 
around quietly, but the important period at last arrives, and 
this is often hastened by a violent action of the abdominal 
muscles, and therefore a pressure on the tumor, sudden blows 
upon the abdomen, coughing, vomiting. Fatal results may 
often follow the rupturing of the cysts. The shock, the hem- 
orrhage, the inflammation may be of such a grave nature as to 
produce death. 

But while there are many cases that have such a rapid ter- 
mination, at the same time there are many that have a far 
more favorable termination. 

In many instances the patient survives the shock, and hem- 
orrhage, and suffers but little local inconvenience, and she con- 
ceives again and has children. 

7 



74 THE INFLUENCE OF THE MOTHER UPON THE CHILD. 



CHAPTER XVII. 

THE INFLUENCE OF THE MOTHER UPON 
THE CHILD. 

There is beauty that is transcendently grand in studying 
the physiology and philosophy of generation, little thought of 
by the mass of mankind. The most of people, and physicians 
are not exempt , are satisfied with the fact that conception takes 
place, and that by to them some unknown law certain effects 
are produced upon the child which are commonly called mother 
marks without ever thinking about the philosophy of the law. 

In fact there is one of the grandest lessons that mankind ever 
learned, and a right understanding of the law governing the 
conception and development of the embryo is an indispensable 
duty of every woman, for in so doing, by a practical applica- 
tion of that knowledge alone is the world to be regenerated. 

For so long as a disregard of the conditions that are indis- 
pensable to a perfect organization is maintained, just so long 
will we have born into the world weaklings, half men and 
women. Now the law of procreation is perfect, and it is no 
fault of the law's that a half or sickly organization is produced 
and given to the world as a result of the conception. 

The fault is in those who shape the conception. Make the 
conditions as perfect as the law, and then in every such case 
we will have given to the world a perfect organization and a 
noble spirit. 

This is no idle visionary theory ; for as sure as the law exists 
and its conditions are complied with, just so sure will the 



THE INFLUENCE OF THE MOTHER UPON THE CHILD. i i) 

thing formed, as the result of the action of that law be perfect as 
the law. There is none so dumb and void of understanding 
as not to admit the fact that mothers do make body marks upon 
their children before they are born in the world. It is no 
more strange for that law to operate, in such a way, conditions 
being favorable, as to make a mind mark or shade, which will 
forever shape the course of the child as sure as the body-mark 
disfigures it in many cases. 

In that way, no doubt, many thieves are made, and prosti- 
tutes also, as well as orators, mathematician s, astronomers, 
philanthropists and the like. So also, may the suicide, mur- 
derer or every other grade of crime. 

In this fashionable age, when women have such a dislike to 
the care of children abortions are frequent, and many attempted 
ones where the child is carried to full term, but with the very 
desire of its mother photographed upon its mind for she goes 
through the full term with a detestation to its life, therefore it 
receives the highest, or at least the soul principle of its mother, 
which, in this case is, that it is an unwelcome child and as 
sure as the law the iniquity of the mother will be visited upon 
. that child. The mother is the camera in which is placed a 
sensitized plate for a picture, that picture will be just what the 
mother, as the camera, lets in through her nervous system 
upon the plate, the embryo. The mission of woman is a grand 
one. To her, and to her alone must we look for that mental 
and physical status that will restore or place our feet upon the 
rock of salvation. She is a mystery ; her womb is God's labor- 
atory ; there the grandest work is performed, surpassing far 
any that ever was or will be. If that development that 
was begun to result in the development of a human being, is 
out short by a departure from the observance of the law, and 



76 ABORTION. 

the development stopped, a monster is produced. Therefore 
females should be taught in all the mysteries of the philosophy of 
life, that they may be prepared for all emergencies, and thus 
avoid the bad effects that so often happen, and be better pre- 
pared to fill that grand mission, that it is her province to be 
called to fill by the great creative law of the universe. In my 
opinion, it is the duty of physicians to use every means in their 
power to the furtherance of that object. The common people 
have been kept in ignorance so long that they think it is right 
to remain there. 



CHAPTER XVIII. 
ABORTION. 

By abortion is meant the premature expulsion of the con- 
tents of an impregnated womb, before the completion of the 
term of gestation. This is apt to occur at any time but 
particulary before the third month; it may also take place during 
a menstrual period with the periodicity of the female genera- 
tive system. If the contents of the gravid uterus should be 
expelled before the sixth month, it is termed abortion, but after 
that time it is called premature labor or miscarriage. 

It is an event that frequently proves very unfavorable to the 
female, and may exert a serious effect on her health. Such 
an occurence, however, is not necessarily dangerous, except 
when accompanied with dangerous hemorrhage. 

Abortion is liable to take place with all women, but it is 
more]common among a certain class of females. Those who lead 
a luxurious life very frequently abort. The laboring class of 



ABORTION. 77 

women it is true, are more exposed to accidents of this kind 
than those who have their comforts and ease, but this liability 
is more than compensated in the one, by the nervous excitabil- 
ity and sensitiveness of the other. All domestic animals are 
liable to loose their offspring prematurely, but in an uncivi- 
lized condition of human society abortions are very rare. 

Statistics from some of our best authorities inform us that 
about one woman in seventy- eight aborts. The process of abor- 
tion consists first, in the separation of the ovum from its attach- 
ment to the walls of the womb, and secondly, in its expulsion 
from the cavity. The loss of blood accompanies its separation, 
and pain its expulsion. 

The embryo may be thrown off at any period of preg- 
nancy and the process completed by uterine action. During 
the early weeks the ovum may pass away whole from the womb, 
or the membrane may burst and the fetus may be expelled 
first and the plecenta afterwaras, or the plecenta first, and the 
fetus afterwards. 

The child may not be expelled for several hours, days, or 
weeks, after it has lost its vitality. It is of the greatest im- 
portance to ascertain whether the fetus be dead or alive. Im- 
portant first, because if it still be alive, proper treatment may 
preserve it, and secondly because if the ovum be dead there 
would be no object in retaining it within the cavity of the 
womb. If the sympathetic symptoms, such as morning sick- 
ness, vomiting, toothache should be suddenly suspended ; if the 
breast should become placid, the abdomen small instead of in- 
creasing, a feeling of weight, &c, there can be but little doubt 
that the ovum has lost its vitality, and gestation is suspended. 
Abortion is generally met with either as accidental or habitu- 



78 ABOKTION. 

al; it may result from sudden mental emotion, or some acci- 
dent which the patient has been subjected to; or it may be hab- 
itual and she may abort continually about the same period of 
pregnancy, without any apparent cause. Females who have 
aborted three or four times in succession at the same period, 
are liable to have a constant recurrence. 

CAUSES. 

The causes of abortion are divided into immediate, predis- 
posing and exciting. Contraction of the womb, is the imme- 
diate cause; the fibers of the womb acting upon the ovum, 
protrude it forth through the dilated orifice in the same way 
that they expel the mature fetus at the end ofgestation. 

The predisposing causes consist principally m circumstances 
debilitating in their character by which the system is under- 
mined, the health impaired, the^nfervous^sy stem shattered, un- 
der circumstances of this character, the child may die for want 
of sufficient nourishment; or the nerves of the womb, par- 
taking of the excitable condition of the nervous condition may 
induce a degree of irritability inconsistent with gestation ; 
abortion may be produced by weakness and plethora, also by 
violent emotions, long walks, passion, fright, grief, diarrhoea, 
lucorrhea, and habits of life. Syphilis, small-pox, fevers and 
diseases of the womb, such as nrward weakness, erosion of the 
neck, follicular ulceration and the like. But it is most fre- 
quently induced by inflammation and ulceration of the mouth 
the cervix uteri and within the cavity. I have known 
patients to abort frequently, and never gave birth to a 
child at full term. I have known others who have giv- 
en birth to one or more, and have miscarried ever after. 



ABORTION. 7!) 

Perhaps the most common cause that exists, as the effects of 
cervical inflammation, or congestion, effusion and great sensibil- 
ity, which cause the womb to contract and thus bring about the 
expulsion of the child. Sexual intercourse during pregnancy 
is a very fruitful cause of abortion ; every intercourse is had 
with risk. Many women are weak, while their animal facul- 
ties are strong, and by receiving violent manifestations from 
the male, subject them to a great deal of danger. When the 
womb is very low, which is often the case, the woman is 
very liable to abort. The existence of the child is perilled by 
sexual intercourse, and its growth is injured, and its charac- 
ter is injuriously effected. The womb being excited, the em- 
bryo is expelled. There is much less danger to abort with 
those females who have neither passion nor pleasure. 

SYMPTOMS. 

When an abortion is threatened there is a sense of uneasiness 
languor, weakness and an aching pain in the back, are expe- 
rienced by the patient, 

After the continuance of these preliminary symptoms for 
sometime, those of labor set in and in a great many cases the 
symptoms are analogous to those of patients at full time. The 
pains at first are slight and recur at long intervals lasting but 
a short time. As the process continues they become more 
intense, and longer ; and the interval between them is much 
shorter. A discharge of mucous or blood, takes place from 
the vagina, pains are experienced in the back, extending 
round the loins to the abdomen and down the thighs recurring: 
regularly, increasing in strength and frequency. The pulse is 
quickened, the skin is hot, voluntary efforts are made to aid 
the womb, and finally the contents are expelled. 



80 PREVENTION OF PREGNANCY. 

But every case is not alike, as regards the symptoms ; 
in some, the child passes out of the womb without a pain or 
hemorrhage, the patient quickly recovering. In other cases 
as is often the case, labor may come on with a considerable 
amount of flooding, and after a time the fetus is discharged, 
the plecental attachments remaining, which are afterwards 
dissolved and expelled with the lochia. While it is retained, 
there is danger of hemorrhage, and when it dissolves, irrita- 
tion may be dreaded. Frequently is it the case that alarming 
hemorrhage sets in. It may take place before the abortion ; 
or it may be at the same time. The hemorrhage may be in- 
ternal or external. If internal, the patient becomes pale, 
exhausted, faint with a black shade under the eyes, and a 
quick, weak pulse with headache, lassitude, slight shiverings, 
dull pain in the pelvis, weight about the rectum, difficulty in 
passing the urine, tightness of the epigastrium, with reaction 
at intervals. The tumor, if above the pelvis, will be unnatur- 
ally tense, and larger than the supposed period of pregnancy 
would warrant. After a short time has elapsed this distension 
gives rise to contraction ; the membranes then break and the 
blood escapes. As a matter of course the child is lost. The 
amount of flooding governs, to a large extent, the instensity of 
the symptoms, and the injury to the constitution of the mother. 
There is less danger at four months. 



CHAPTER XIX. 

PREVENTION OF PREGNANCY. 

The divine creator has implanted in the breast of the female, 
an all-absorbing, all-controling desire for offspring. The 



PREVENTION OF PREGNANCY. 81 

pains and perils of child-birth are not dreaded except in those 
in whom disease exists. 

The fact is well known to physicians if not to others, that a 
large portion of women in civilized society, are deformed, their 
health impaired, and their lives shortened by too frequent preg- 
nancies. Year after year thousands are sacrificed at this 
shrine and women are to a greater or less extent resorting to 
means to prevent pregnancy. Women can recognize no higher 
law than that of self-preservation, and no greater duty than 
bringing into the world healthy vigorous children or none at 
all. 

There are certain conditions that justify married women 
from becoming pregnant. Namely, where there is malforma- 
tion and disease to such an extent as that the life of the female 
would be endangered. 

And there are a great many such cases as this. It is thought 
that nearly one fourth of the women of our large cities are mal- 
formed, or constitutionally frail and diseased, so that they can- 
not become pregnant without great risk to their lives ; while 
others are so contaminated with scrofula that they ought not to 
become mothers. 

But then a woman who is unfit on account of deformity and 
disease, to bear children, ought not to marry. But if mar- 
riage does take place, how is she to help herself? As soon 
as the impregnated ovum becomes attached to the walls of the 
womb the process of development commences. The period 
of conception is limited to a week before and after menstrua- 
tion, so that there are about two weeks in each month, a 
period in which conception will seldom occur. 

This however is not infallible. As a general thing in an 
ordinary healthy patient the ova pass off in a few days after 



82 PREVENTION OF PKEtJNANCY. 

the menstrual flow, so that if sexual intercourse is abstained 
from until ten days afterward pregnancy will not be likely to 
take place. Fixation to the uterine walls, is the starting 
point of pregnancy ; if there should be any sudden motion or 
jarring, anything that agitates the pelvic viscera and causes 
the womb to contract vigorous^, it will prevent pregnancy. 
Purgatives, violent coughing, sneezing have the same effect, not 
because they expel the semen, as many suppose but because 
they cause disturbance and create contraction, and if the con- 
tractions are sufficiently strong the egg is apt to be expelled. 
Others use successfully the injection of tupid water into the 
vagina after a successful coition. 

The silk spunge is used by some women ; they insert it up 
against the neck of the womb, and, were it possible for it to 
remain there, it might serve a good purpose. But no matter 
how effectual a plan it may be, it certainly is a bad practice 
as it has a tendency to produce irritation of the neck of the 
womb. But in this age of fashion women are resorting to 
means to prevent child-bearing, which in its nature is crim- 
inal. Pregnancy and the care of children deprive them of the 
privilege of attending balls, parties, and other amusements, as 
was their habit before marriage, and therefore every means is 
resorted to, no matter how demoralizing, for the purpose of 
preventing or relieving pregnancy. We mean abortion. This 
is not confined to the single who become illegally pregnant, 
but it is very common with the married. Few outside of the 
medical profession, know how common is this crime; and the 
history of almost every physician is full of instances where he 
has been solicited to become a participant in this unholy and 
illegal slaughter. It is very gratifying to be able to record to 
the credit of those physicians possessed of sterling integrity 



PREVENTION OF PREGNANCY. So 

who withstand the temptations placed in their way, and who 
utterly and absolutely refuse to become connected with such 
criminal proceedings. Criminal abortion, with a very few ex- 
ceptions is confined to Americans and Protestants. The Rom- 
an Catholic foreigners, are rarely guilty of the offence, because 
the cause of the church would at once be upon them. This 
may seem to be a very strange assertion to make, nevertheless, 
it is true. Every pregnant Catholic, by her condition, prom- 
ises an accession to the church, and therefore a prospective ad- 
dition to her power over Protestantism, and as soon as the 
birth of the foreign Catholic population shall exceed those of 
the native or Protestant population, it is not a very difficult 
matter to calculate the result. 

Reiterating what was said in another part of this chapter? 
those women who are so deformed or diseased as that child- 
bearing would endanger their lives, ought to remain single, 
and those who are in good health and enter into matrimony, 
should, in the very nature of things, expect to become mothers. 



PART II. 



CHAPTER I. 
PARTURITION OR LABOR. 

This consists in two things ; namely, the expulsion of the 
child and its appendages from the womb, and its separation 
from the mother. 

It is a grand function of the uterine system, a perfectly natu- 
ral process. It is just as natural for a woman to bear a child, 
as for a tree to bear fruit. 

The time at which labor takes place is reckoned at the end 
of nine calendar months and a week, ten lunar months, forty 
weeks or 280 days, a few days sooner or later. 

Like menstruation, lactation, puberty, labor is a normal 
process ; to say that it is a pathological condition or an abnor- 
mal or morbid process, is absurd in the extreme. 

Physiologists of all ages have endeavored to assign causes 
for labor, in view of the magnitude and importance of the event 
and the regularity with which it takes place > 

Why the womb expels its contents at the expiration of nine 
calendar months, from the time of conception, is a very diffi- 
cult question to solve ; what is the average height of men, or 



PARTURITION OR LABOR. 85 

why does the earth revolve on its axis, are no more difficult 
problems, yet it suffices us to know that it is a law of reproduc- 
tion and occurs usually not until the child is capable of an inde- 
pendent existence ; and not until a time when the womb has 
acquired organic development and sensibilities which enable 
it to perform its great work. When its muscular fibres con- 
tract, its cavity diminishes, its contents are expelled. Differ- 
ent theories have been given as to the expulsion of the child at 
the ninth month. 

Excitement of the ovaries has been assigned a cause, but 
this does not give a full explanation. The ovarium is connec- 
ted with the rest of the parturient canal by a series of reflex 
ares. 

That portion of the spinal centres which presides over the 
action of the womb, is at the end of utero-gestation thrown into 
a state of excitement by means of the spinal excitor nerves of 
the ovaria. The nervo motor system of the womb being thus 
thrown into a state of excitability, the womb firmly contracts 
upon its contents, the child itself hitherto defended by the 
liquors amnii, becomes an ordinary excitor, and the reflex 
action of labor is gradually established. 

It is thought by some that the contractions of the womb are 
brought on by the struggles of the child, for want of sufficient 
nourishment; and from the constraint of its position, by the 
acid nature of the liquor amnii, like the dropping of rich fruit. 

At the completion of gestation the womb, which during the 
period of its growth was inert allowing itself to be evolved 
and acquiring an astonishing size, begins a new action, which 
constitutes the function of labor. Parturition embraces the 
dilatation of the passages as well as the expulsion of the child. 
Parturition and conception generally occur at a monthly pe- 

8 



86 PARTURITION OR LABOR. 

riod, and the normal period of labor corresponds to the men- 
strual period, so that pregnancy as a general thing occupies 
'280 days, and just so much more or less as impregnation takes 
place immediately before or after menstruation. 

THE MECHANISM OF LABOR. 

The mechanism by which the expulsion of the child is effec- 
ted, is an important and interesting subject to consider. 

EXPULSIVE FORCE. 

In all cases of parturition the womb is the principle agent 
in the expulsion of the new being. The expulsive action of 
the womb resembles very much the alimentary canal in expell- 
ing its contents. When the uterine contractions are once 
fully established, they can continue independent of the mother. 
This is manifest in those cases where chloroform is adminis- 
tered, although the mother is unconscious from its influence f 
yet the womb is still engaged in performing its work of expell- 
ing the offspring. The womb, though not muscular, posses- 
ses all the characteristics of muscularity. 

At the time of labor the fibres of the womb contract, shorten^ 
thicken, and by their joint action diminish the size of the cav- 
ity of that organ. Each of these contractions is a pain , peri- 
odical in its nature, with distinct intervals. 

We understand then, by the term pain, contraction of the 
muscular fibres of the womb. The pain corresponds to the 
force and duration of each effort of the womb. The arrange- 
ment of the muscular fibres of the uterus is such, that its cav- 
ity is diminished by each contraction, at the same time the 
mouth is dilated. 



PARTURITION OR LABOR. 87 

Each pain is of but short duration, and is succeeded by a pe- 
riod of relaxation or repose corresponding very muck to the 
duration of the pain. The child by these repeated contrac- 
tions, is gradually pressed against the mouth of the uterus, 
which at the time is enlarging, until at last the dilatation is 
flcient to admit of the passage of the child. 

The neck of the womb is where the contractions begin, and 
gradually continuing until general action of the womb is the 
result. As the pains increase the suffering augments, and 
the pain becomes stronger and stronger, being at first in 
the loins and abdomen, then extending down the thighs, and 
are called cutting or grinding pains. The longitudinal fibres 
of the womb, in true labor contract from above downward, 
and the abdominal and respiratory muscles co-operate, and in- 
duce a pressure upon the whole abdominal and pelvic viscera, 
attended with a sense of bearing down. In case the pains are 
irregular and spasmodic and not of a bearing down nature at 
full term, they are false labor pains. The pains known as 
preparatory, are slight, resulting from feeble contractions of 
the fibres. 

The suffering attending labor is increased by the non-obser- 
vance of natural laws, and by uterine diseases and impaired 
nervous system. Such affections as inflammation, conges- 
tion and ulceration with displacement of the sexual organs are 
very prevalent, and they increase with our so-called civiliza- 
tion. Let us add to these the thousands of dyspeptic stom- 
achs, constipated bowels, weak abdominal muscles and spinal 
irritation, and we have a good reason for the increased suffer- 
ing of pregnancy, and the dreadful pains and perils of partu- 
rition 



88 PARTURITION OR LABOR . 

CAUSE OF SUFFERING. 

The suffering of parturition is due to several things ; namely, 
the forcible distention of the neck of the womb, the pressure 
of the fibres during contraction upon the nervous filaments, 
and upon the dilatation of the passages. 

It is the peculiar character of every contraction, to be 
feeble at first, and to gradually increase until it arrives at its 
maximum intensity of violence and force, remain stationary 
and then slowly subsides. Before these contractions or pains, 
after they have reached their maximum power, as a general 
thing, every obstacle yields, and delivery is accomplished. 

There is a periodicity, a characteristic of these contractions, 
which is very remarkable: an interval of rest follows each 
pain, which interval gradually becomes shorter as labor advan- 
ces. 

It is natural for the pains to begin in the neck or cervix of 
the womb, and as labor progresses, the body and fundus are 
gradually involved. The womb becomes hard, round and prom- 
inent during the process of parturition, and the fundus is tilted 
forward. After the subsidence of the pain, it softens, but does 
not assume its former flaccidity. 

The amount of force exerted by the womb depends upon 

i 

many causes, such as the strength of the patient, the charac- 
ter of the pains, and the obstacle to overcome. 

The action of the womb is independent of the will ; mental 
excitement may have some indirect enfluence upon it Emo- 
tion has a direct influence, reflex action is the great physiological 
power, without which the function of parturition cannot be 
properly performed. 



PARTURITION OR LABOR. 89 

THE PASSAGES. 

Let us consider the diameter of the pelvis. The inlet of the 
pelvis has a somewhat heart-shaped appearance, and has 
three principal diameters. They are as follows : First the an- 
teroposterior, which extends from the sacro- vertebral angles 
to the symphysis pubis, its measurement being four inches. 
Second, the transverse, which extends across the greatest width 
of the inlet, from the middle of the brim on the one side, to 
the same point on the opposite, its measurement being five 
inches. 

The oblique, which extends from the margin of the pelvis, 
corresponding to the ileo-pectineal commences on the one side, 
and to the sacroiliac symphysis on the opposite side, it meas- 
ures five inches, 

THE CAVITY OF THE PELVIS. 

The front is quite shallow, an inch and a half being its 
measurement in depth, at the symphysis three inches and a 
half in the middle, and four inches and a half posteriorly. 
The diameters of the outlet are two. The antero-posterior 
which extends from the tip of the coccyx to the lower part of 
symphysis pubis, the average measurement of which is four 
inches. The transverse, which extends from the posterior part 
of one ischiatic tuberosity, to the same point on the opposite 
side, the average measurement is four inches. The length of 
the coccyx is variable, and in view of this fact, the antero-pos- 
terior diameter may be increased or diminished. The , plane 
of the superior strait, is an imaginary superficies, its anterior 
margin being at the symphysis pubis and its posterior at the 
promontory, while the rest of its margin is in contact with the 



90 



PARTURITION OR LABOR. 



inner lips of the liner ileo-pictinea. The woman standing 
erect, or laying straight on her back, the plane of the strait dips 
at an angle of 50° to the axis of the body, but in case the 
trunk should be inclined forwards, the dip is considerably 
less, or backward, and is increased ; such knowledge as this is 
important for all to have, but especially so, as far as the phy- 
sician is concerned, and all who may be engaged in the practice 
of midwifery, for it enables him to direct his patient to extend 
her trunk, or flex it more or less, the object being to secure the 
plane of the superior straight into a position, that will be favor- 
able to, and assist the presenting part of the child into the 
superior strait, and its passage through it. 

We have frequently observed women in labor as if prompted 
by an instructive sense of the reality of it, bending the trunk 
over the abdominal strait so that the process of labor may be 
hastened. 

In being called to cases of parturition we have often found 
the child's head that in one inclination of the plane would be 
driven against the symphysis pubis, whereas with a lesser 
inclination of the plane, it would at once plunge to the bot- 
tom of the pelvis. 

PLANE OF THE INFERIOR STRAIT. 

Anatomists usually mention it as bounded by the inner lips 
of the two tuberosities of the ischial bones, the rami of the 
ischia, and pubis, the ischia-sacral ligaments, and the joint of 
the coccyx. It is generally supposed that the inferior strait 
is single, but the^truth is, there are two such plains, the ante- 
rior and posterior inclined plains of the perineal strait. 

In order that the child might escape from the womb, it 
first comes in contact with the posterior inclined plane, de- 



PARTURITION OR LABOR. 



91 



pressing it at first, and afterwards depressing the posterior 
edge of the anterior inclined plane. The child having escaped 
between them they resume their place like two valves, the 
margin of which had first been separated and then allowed to 
close again. There are certain mechanical effects which these 



* A 






m oT 




THE FEMALE PELVIS. 

A.— Represents the five vertebrae of the loins. B — The Os Sacrum. 
Oj-The Os Coccygis. l\ D.— The Ossa Ilium. E. E.— The Ossa Ischium. 
F^The Ossa Pubis. G.— The Foramina magna. H. H.— The Acetabula. 
I.I.I. I.I.I —The brim or the circumference of the cavity of the pelvis. 



92 PARTURITION OR LABOR. 

peculiarities are designed to produce upon the passage of the 
child's head. 

1. Certain diameters only of the child's head correspond to 
certain diameters of the pelvis, therefore the gradual change 
must be caused by a similar change in the position of the head ; 
the head is pressed forward by the expulsive force, but it can 
only progress in harmony with the mutual change of the 
diameters of the head of the child and the pelvis. 

2. There must be a change effected ,in the direction in 
which the child's head moves, by a change in the direction of 
the axes, and the effect of the inclined plane ; they change it 
from the axes of the brim to that of the outlet. In order to 
secure such an adjustment of position and change in the diam- 
eters, two things are necessary. 

1. There must be a continuation of the pains with the appro- 
priate intervals. 

2. The child's head must correspond to the size of the pel- 
vis. In the first place, should it be two small it will require 
due assistence, and in the second place should it be two large 
it will not pass at all. 

In order to be accurate, in estimating the passages, we 
must consider the uterine cavity as one extremity of them. 
As a usual thing the long axis of the childs head corresponds 
with the long axis of the womb, but previous to labor the lat- 
ter is not in accordance with the long axis of the brim of 
the pelvis but more perpendicular ; this is remedied however, 
by the contractions of the womb tilting the fundus or upper 
part of the womb forward thus the child is placed in proper 
direction to enter the pelvis. There are some obstacles 
with which the head meets in its progress, let us therefore, 
notice what they are. first : 



PARTURITION OR LABOR. 93 

THE NECK OF THE WOMB. 

This frequently offers a considerable amount of resistance. 
And the resistance is the effect of muscular action and of 
its elastic cellular tissue. The dilatation of the neck at first 
is purely mechanical and is effected not by one great effort, 
but by frequent ones the dilatation being aided afterwards by 
muscular action. The neck becomes somewhat dilated during 
the last several weeks of gestation, and the result is the early 
pains, that it is retracted, and the membranes becoming dis- 
tended with waters pressed down in a pouch. By this is formed 
a wedge, which is adapted to the size of the mouth of the 
womb, and as the fibres of the body and fundus of the womb 
are stronger than those of the neck, this wedge is forced 
down into and through the mouth of the womb with each pain, 
dilating it to the size of the wedge, and continuing the process 
until the membranes give, and the waters are allowed to dis- 
charge. After this mechanical dilatation has ended, which 
takes place when the membranes are bursted, and the waters 
discharged, the child's head is substituted for the wedge of 
membranes, when retraction of the fibres of the neck is the 
result. 

THE BONEY CIRCLE OF THE BRIM OF THE PELVIS. 

The head of the child enters this circle by the adaptations 
of certain of its diameters to those of the pelvis, and the appo- 
sition is perfect, so that it requires a degree of compression of 
the head to facilitate its enterance. This is very considerably 
aided by the head being placed in an oblique position every 
way, and the pains gradually affecting it. At the completion 
of this compression and the attainment of the due position, the 



94 PARTURITION OR LABOR. 

head is gradually propelled into and through the cavity. A 
little after each pain the head somewhat -recedes, but again 
advancing until it arrives at the lower outlet when it meets 
with another obstacle such as the ligaments, muscles, cellular 
tissue, and externally the perineum. 

Nature has provided the mucous secretions as a means b y 
which these soft parts are softened and prepared for dilatation, 
and the parts becoming completely relaxed and fully distended, 
they yield, and the head being directed forward by the di- 
rect curve of the sacrum, comes in contact with the vaginal 
opening and is gradually forced through it. 

There is a difference in the amount of resistance in different 
patients. 

In women of advanced life, and in those giving birth to 
first children, it is usually greater than in others. 

And in the second stage it is greater than in the first, but 
does not continue so lcng ; its being quickly overcome is due 
to the amount of force employed. So the obstacles mentioned 
above constitute the natural divisions of labor into stages, let 
us notice what these stages are. 

STAGES IN LABOR. 

The fact of there being three stages in the process of labor 
is not understood by females. The first begins at the time 
labor sets in and extends to the passage of the head of the 
child through the mouth of the womb, the second commen- 
ces at this point, and terminates with the birth of the child, 
the third involves the time from the delivery of the child to 
the expulsion of the after birth. 

The length of each stage varies according to the power em- 
ployed. 



PARTURITION OR LABOR. 95 

But another influence in the mechanism of parturition is the 

CHILD. 

The child is a passive agent, and its mechanical influence 
is considerable. The uniformity in the measurement of the 
childs head, is pretty reliable 




DIAMETER OF THE CHILDS HEAD. 



1. The longitudinal diameter is 4 to 4 J inches. 

2. The transverse " " " 3J " 4 " 

3. The oblique " " " 5 

The longitudinal diameter corresponds to the oblique diame- 
ter of the brim and anteo-posterior of the outlet ; the trans- 
verse to the anteo-posterior diamiter of th'e lower outlet. In 
many cases, the oblique to the anteo-posterior diameter of 
the lower outlet in face presentation. 

The transverse diameter of the shoulders is from 4f to 5 
inches. The transverse of the hips 4 to 5 inches. These 
diameters are angles with the long diameter of the head, there- 
fore when the latter corresponds to the long diameter of the 



96 PARTURITION OR LABOR. 

outlet, they will be precisely in apposition with the long di- 
ameter of the brim.. Though in well developed infants the 
measurements are quite uniform and closely correspond to 
those of the pelvis, yet there are certain adaptations that 
gratley facilitate the transit of the child, namely, the com- 
pressibility of the child's bead. In view of this compressi- 
bility the head is forced through the pelvis. Generally the 
head of a male child is larger at birth then that of a female 
And more mothers die during labor with male children than 
with female. Complications and difficulties occur more fre- 
quently in the birth of males than females. There is a larger 
number of male children still born, that die during labor, and 
in early childhood than female. In order to have a through 
knowledge of the mechanism of parturition, it is necessary 
to have an acquaintance with the different presentations and 
positions of the child. But it would require too much space 
in a work like this to give a full explanation of this part of 
the subject. Therefore let us proceed to notice the symptoms 
of labor. 

SYMPTOMS. 

It is important for us to notice certain signs, which indi- 
cate the approach of labor. These are called premonitary 
symptoms. They vary in intensity in different patients ; in 
some they are so slight, as scarcely to be noticable and in 
others they are very distinct. The principal symptoms of this 
class are 

SUBSIDENCE OF THE ABDOMEN. 

This commences in the early part of the ninth month, 
but within the last week the uterine tumor becomes much less 



PARTURITION OR LABOR. 97 

and sinks forward. This is in consequence of the lower end 
of the womb sinking into the pelvis as well as relaxation of 
of tissue of the womb permitting a greater amount of expan- 
sion and greater diminuation of its height. Relaxation of 
the abdominal parieties is the cause of the tilting forward. 
The sinking of the womb is effected by the action of the di- 
aphragm and muscles of the abdomen. 

FREQUENT DESIRE TO URINATE. 

The cause of this is very apparent. As the womb becomes 
larger, compression is made upon the adjacent viscera, and it 
settles down in the pelvis, and tilts forward. During the last 
month of pregnancy the pressure upon the bladder is quite con- 
siderable and in view of its diminished capacity, frequent eva- 
cuations are necessary. 

And a means by which the irritability is increased is the 
reflex influence, from the womb to the* bladder ; therefore it 
is reasonable to be supposed that it is less able to bear the 
presence of the urine than under ordinary circumstances, this 
is liable to occur at any time in pregnancy, but it is more 
common at the termination of gestation. 

PAINLESS CONTRACTIONS OF THE WOMB. 

It is common for these to be experienced about the termina- 
tion of the last month of pregnancy. They invariably occur, 
and the womb is felt to be hard, and well defined. The 
womb contracts itself and gets ready for the great and grand 
effort at expulsion, first settling lower down; the breathing 
becomes freer, the patient lighter, the mouth of the womb 
dilates as also does the vagina. Sometimes there is a chill at 

9 



98 PARTURITION OR LABOR. 

the commencement. These preparatory exhibitions are accom- 
panied with a discharge of a glary mucous which is commonly 
called the 

SHOW. 

This continues until labor is completed. It usually makes 
its appearance about twenty-four hours before labor proper 
sets in, and it serves to prepare the passages for the easy 
transit of the child. In some cases the show has been known 
to appear several days before actual labor, and often it is ab- 
sent. Such cases however are comparatively few. 

GRIPING AND DIARRHEA. 

This however, is an uncertain sign of the approach of partu- 
rition as it may originate from an irritable condition of the 
bowels. In advanced stages of pregnancy, it is due to me- 
chanical and reflex a|fcion, which are induced by the sympa- 
thy at the time existing between the intestines and womb. 

SYMPTOMS OF LABOR. 

Labor commences from the moment that the action of the 
womb becomes painful. The entire uterus must be engaged 
in the work, and the pains must recur regularly and continue 
without suspension. 

It is often the case, however, that the womb acts partially, 
irregularly, and inefficiently and such efforts are termed false 
pains. There is a great variety of circumstances upon which 
these false pains are dependent, such as over-fatigue indiges- 
tion, constipation, cold. The fact that these pains begin at 
the upper part of the womb, are limited in extent, and may 



PARTURITION OR LABOR. 99 

or may not recur at regular intervals, are not attended 
with any mucous discharge, and do not dilate the mouth or 
protrude the bag of waters, render them distinguishable from 
the true pains. False pains are liable to take place at any 
time, and frequently give rise to a great deal of trouble and 
distress. Labor pains proper when commenced, recur at reg- 
ular intervals and increase in intensity, power and frequency 
until they arrive at their maximum, remain stationary for a 
time, and then subside. 

The stage of labor, governs, to a great extent, the charac- 
ter of the pains. There are two kinds, cutting and grinding, 
and bearing down, or forcing pains. 

The cutting or grinding pains are peculiar to the first stage, 
and are present during the dilatation of the mouth of the 
womb. 

They do not occur frequently, are short but quite severe. 
Such is the character of these pains, that the patient is com- 
pelled to desist from whatever might have been engaging 
her attention, and even respiration is partially arrested. So 
severe are the pains that she endures considerable suffering, 
and we hear her giving vent to her feelings by groans and 
cries. In the first stage the patient is constantly changing 
position, her spirits become depressed, and she manifests a 
great degree of irritability and peevishness ; sometimes tem- 
porary delirium supervenes, evidence of which is given in the 
unconsciousness and in-coherent talking of the patient during 
this stage. 

Just as the head passes through the mouth of the uterus 
severe rigors are experienced resulting not from cold, but 
from nervous sympathy. 



100 PARTURITION OR LABOR. 

This stage is also characterized by irritability of the stomach, 
and vomiting is the result ; this is usually the case during the 
dilatation of the neck, which has a good effect in relaxing 
the mouth of the womb. With each pain the protrusion of 
the membranes is increased, though with subsidence of the 
pain the membranes reced. This state of things continues 
from four to ten hours ; when at last under the pressure of one 
of these contractions, the membranes give way, and the wa- 
ters are discharged, and the child's head is brought, with 
each paroxysm, against the inner surface of the neck, and the 
mouth of the womb. The bag of waters may be ruptured at 
any time during the first stage, but when it takes place at a 
very early period, delivery is retarded, and is likely to be at- 
tended with some difficulty. 

The attending physician, in view of the fact just stated, 
should endeavor to retain them entire until there is sufficient 
dilatation of the os uteri. The first stage is brought to a ter- 
mination by degrees, the mouth of the uterus becomes well 
dilated, there is an increase of the, sanguineous streaks in the 
discharge from the vagina. Voluntary efforts having com- 
menced they gradually increase, and now as the first comes to 
a termination, the membranes rupture, and the head is forced 
through the mouth of the womb, at which time it enters the 
second stage. By this time the whole appearance of things 
has undergone a change, the pains having become more 
frequent, longer and stronger, the intervals are shorter, 
suffering increased, muscular exertion more manifest, breathing 
suspended during a pain, the outcry is suppressed except as 
the pain subsides. 

As each pain comes on, the patient holds her breath, 
grasps the bed clothes or the hand of the physician, nurse or 



PARTURITION OR LABOR. 101 

some one else who may be standing near her, and she brings 
into requisition the muscles of the extremities, back and abdo- 
men to aid the womb in its expulsive efforts. These we call 
the bearing down pains. 

The cause of the change in the character of the pains 
has not been very well understood, and consequently not 
explained. Some writers attribute it to the presence of the 
childs head in the vagina, or the increased resistance and 
the necessity for more power to overcome it. I am of the 
opinion, that it is largely due to the reflex action, from pres- 
sure upon .the lips of the womb and soft parts of the cavity 
and outlet. During each pain the cutaneous vessels become 
distended which is due to the arrest of the circulation, the latter 
being the result of suspension of respiration. 

The other symptoms here exhibited are very significant. 
The surface becomes florid, the face assumes an almost purple 
appearance, the veins of the forehead, temples, and neck are 
distended, eyes bright and prominent, the heat of the skin is 
increased, perspiration profuse, the pulse, which was compara- 
tively quiet in the first stage, becomes more frequent, until 
reaching its greatest intensity, it remains stationary for a 
time and then subsides. Sometimes it is the case that vomi- 
ting occurs during the second stage, it being the result of 
pressure and reflex irritation ; it is to be regarded however, 
as a favorable omen, except under certain circumstances, such 
as when it comes on with symptoms of collapse up on the sud- 
den cessation of uterine action, attended with a rapid pulse, 
furred tongue, heat of skin, tenderness of the abdomen. In 
case the second stage should be prolonged, and the patient com- 
plains of heaviness and manifests a desire to sleep, and sleeps 
between the pains as the result of fatigue, connected with con- 



102 PARTURITION OR LABOR.' 

gestion of the head and face, as a general thing, we would not 
regard it unfavorable, but should it be excessive, accompanied 
with headache, it is time for the physician to be on his guard 
against convulsions. As the head passes through the pelvis, 
it presses to a greater or less extent upon the nerves which 
pass through the cavity to the limbs, which gives rise to 
spasms and cramps. If the physician makes an examination 
at the commencement of the second stage, he will find the va- 
gina dilated rugous, and flabby, prepared to yield to the 
child. The head of the child can be felt with comparative 
ease, at the upper part of the pelvis; it descends with each 
pain, and recedes at its subsidence, the advance however is 
greater than the recession. 

After a while the head will have reached the floor of the 
pelvis, at which point it meets with considerable resistance, 
but the natural powers finally overcome this resistance, and 
all obstacles yielding, the perineum distending in consequence 
of the pressure of the head. At this stage of labor the suffer- 
ing and exertion reach their greatest point ; the perineum and 
external orifice are distended almost to their utmost capacity. 
Great expulsive force is called in requisition, and see how 
beautifully nature has provided for the protection of the pa- 
tient, were this force to be continuous, nothing perhaps could 
save her from being harmed ; but each pain continues just 
long enough to gain upon the advance of the preceeding one, 
and the head retained at its furthest place of advancement, and 
then recedes ; and these efforts are repeated until the per- 
ineum is thoroughly softened, and the external orifice is di- 
lated. 

Frequently at the termination of this stage, the pains are 
double, following each other in quick succession, so that before 



PARTURITION OR LABOR. 103 

one has fully ended, another comes on, causing the patient 
to give expression to her sufferings in an agonizing cry. Fi- 
nally the pains conquer all resistance, and with one spell of 
agony the head makes its appearance, then a short rest super- 
venes, and very soon with one more effort the child is born. 
Very soon after the head is born, the child begins to respire. 
With the expulsion of the child the second stage terminates. 
The suffering during this stage is the most intense, but it is 
changed for a perfect rest. I have heard patients say just 
after the expulsion of the child, that their ease was inexpres- 
sible, now the second stage having ended, the third stage sets 
in which includes the detachment, and expulsion of the ple- 
centa or after-birth. 

In a great many cases the after-birth is detached by the 
contractions which expell the child, but it usually remains in 
the womb from whence it is delivered, either by natural 
powers or by the aid of the physician. The time which 
elapses from the birth of the child to the delivery of the 
after-birth is governed by the tone or fatigue, the womb has 
endured; it is usually from five to thirty minutes. In case 
it has not been managed scientifically, the time may be a 
great deal longer, but generally it is within an hour. 

RETAINED AFTER-BIRTH. 

As has been stated, the detachment and delivery of the 
after-birth constitutes the third stage of labor. It is unusal 
for it to be expelled by the natural powers, if not delivered 
by the physician within an hour from the birth of the child ; 
but when the time exceeds an hour it is regarded as retained 
after-birth. There are however exceptions to this rule, as 



104 PARTURITION OR LABOR. 

when the womb has been overfatigued, so that it does not 
resume its contractions. The womb is a muscular organ, and 
becomes exhausted, and fatigued, it therefore needs rest before 
it resumes its work , when it does resume, it contracts and expels 
its contents Sometimes if left to nature it is retained, and 
putrefies and produces inflammation of the womb. The after- 
birth should be got rid of as soon as possible, for the female 
has no security, so long as it is allowed to remain. I can 
see no reason why the physician should wait for pains for 
the expulsion of the plecenta The causes of retained after- 
birth are inertia of the womb irregular contractions, and 
morbid adhesion between the womb and plecenta. 

AFTER PAINS. 

After the contents of the womb have been expelled, the con- 
tractions are unaccompanied with pain in those who have not 
born children before, but those who have given birth to more 
than one child, suffer more or less from what is known as 
afterpains. They vary in severity, intensity and duration, 
as a general thing commencing about an half hour after 
delivery, and ceasing within forty hours, sooner or later. 

They are important ; during their continuation the discharge 
from the womb is increased, clots are expelled ; these pains 
prevent hemorrhage and diminish the size of the womb. 

MORBID ADHESION OF THE AFTER-BIRTH. 

In many cases we have a morbid adhesion, between the 
after-birth and womb, which sometimes gives to the physician 
a considerable trouble in breaking up that adhesion, it is at- 
tended with some danger in view of the hemorrhage that may 
result. 



PARTURITION OR LABOR. 105 



CAUSES. 



It is undoubtedly, due to some unusual morbid condition of 
the after-birth and womb which do not relate to parturition . 
Inflammation, induration, calcareous, scirrhus deposits may exist. 

HEMORRHAGE. 

t 
Among the various deviations from the ordinary course of 

labor, there is not one perhaps that is so preplexing and try- 
ing to the physician as flooding. True, there is great danger 
connected therewith, but it is not that so much he has to try 
him, as it is its rapidity, and the impossibility of waiting for 
help. There are two forms of hemorrhage, each having their 
different causes, yet both dependent upon the position of 
the plecenta. The one is called accidental hemorrhage. The 
cause of this variety is the partial and accidental separa- 
tion of the after-birth, though at the same time it occupies 
its usual position. The next variety is called unavoidable 
hemorrhage, from the fact that the after-birth being placed 
partially or wholly over the mouth of the womb, the dilatation 
will unavoidably separate the after-birth. 

ACCIDENTAL HEMORRHAGE. 

As has been already intimated in accidental hemorrhage, 
the after-birth is in its normal position. In view of the sepa- 
ration of some portion of the after-birth from the walls of the 
womb, and laceration of its vessels, and the impossibility for 
them to close by contractions, because of the fullness of the 
uterus the blood is poured profusely out. We have to estimate 
the amount of blood, lost in a given case by the extent of the 



106 PARTURITION OR LABOR. 

surface exposed. Although this cannot always be depended 
upon, for partial hemorrhage may arise from a small spot, if 
there is exposure of a large blood vessel. It may be in some 
cases, that a portion of the centre of the after-birth is detached, 
forming a cavity which may be filled with blood, but the su- 
rounding adherent after-birth prevents its escape externally ; 
or it may be extended beyond the after-birth, and retained by 
adhesi'on. In view of the extravasation which takes place, there 
is a hardness about that particular spot, and a seeming, if not 
a real enlargement of the womb. If the quantity is very 
much, the size increases, the womb feels firmer, more tense, 
strength diminishes, fainting fits take place, before, very long, 
weak slow pains are felt, in case the detachment be great, 
the weakness increases. There may be no coagula from the 
mouth of the womb. The hemorrhage at first is internal and 
afterwards external. 

CAUSES. 

The causes of occidental hemorrhage are various and many ; 
violent shocks, blows, falls, exertion, fatigue, straining &c. 
These detach a portion of the plecenta. In addition to the 
above causes, we have a diseased condition of the after-birth, 
plethora, increased action of the vessels of the womb. Hem- 
orrhage may take place while labor is going on, the after- 
birth becoming more or less detached by the action of the 
womb, and it may prove fatal. 

SYMPTOMS. 

Having alluded to the exciting causes, we now mention 
the accompanying symptoms. Discharge, local uneasiness, dull 
aching pain in the back, and abdomen and faintness. 



PARTURITION OR LABOR. 107 

The flooding may be internal during labor, and if so, none 
may escape after the expulsion of the child, or after-birth. The 
discharge does not depend upon the presence of pain, but it 
may take place without. 

Their is a great difference in the amount discharged, varying 
from four ounces to a large quantity. In case of profuse 
discharge, the patient will sometimes faint, and during syn- 
cope the discharge may be arrested. But besides the above 
we have a blanched surface, and covered with cold perspira- 
tion, a sunken countenance, dark circles around the eyes, weak 
fluctuating pulse. And as the hemorrhage continues, these 
symptoms increase ; dimness of the sight, ringing in the ears, 
sighing, intolerance, restlessness, uneasiness, jactitation, and 
death, preceded by faintings, and convulsions. It is well to 
state however, that a fatal termination is not always in pro- 
portion to the amount of blood lost. Labor pains may come 
on, or they may be entirely absent. A good deal will depend 
upon the period of pregnancy, at which this complication 
occurs. It will be observed, if they do come on, that during 
a pain the hemorrhage will be arrested, and at the termination 
of the pain, the bleeding will return. Very rarely will the 
mouth of the womb be found dilated in the absence of pain, 
but the neck, as a usual thing is softened, and relaxed as a 
result of the discharge. Such a complication, is extremely 
dangerous. 

UNAVOIDABLE HEMORRHAGE. 

It is sometimes the case that the after-birth is presented 
first in labor, situating itself either partially or wholly over 
the os uteri or coming down only to the edge of the cervix 



108 PARTURITION OR LABOR. 

uteri. In this case, hemorrhage is a necessary consequence of 
the dilatation of the mouth of the womb. The collection be- 
tween the after-birth and womb is separated, and in proportion 
to the advances in labor, until the head passes through the 
mouth of the womb, will be the amount of disruption, and 
hemorrhage. 

The after-birth being separated from the cervix uteri, and 
the exposed mouths of the torn vessels exposed, is undoub- 
tedly the cause of the variety of hemorrhage, now under con- 
sideration. It is supposed that the cause of plecenta previa 
is attributable to the dropping of the ovum, at the moment of 
its passage from the fallopian tube into the womb, from fear 
of undue mental or physical excitement. 

SYMPTOMS. 

About the seventh month, or a few weeks before labor comes 
on, their is a slight discharge of blood, which indicates the 
condition of things under consideration. This discharge 
varies in different cases until the womb begins to contract when 
it comes on profusely, and increases with each pain. If there 
is ahead presentation, the physician on making an examina- 
tion, will find the after-birth situated entirely or partially 
over the mouth of the uterus, or down to its margin. He 
will feel the mouth of the womb closed by a thick soft spongy 
mass. Its edge can be readily, and distinctly felt, as also the 
presentation through membranes covering the remaining por- 
tion of the os uteri. 

In case their is a feet presentation, with only partial im- 
plantation of the after-birth, they may pass through the os 
uteri ; and notwithstanding the detachment of the after-birth 



PARTURITION OR LABOR. 109 

will increase with the dilatation, yet the flooding will be ar- 
rested by the pressure of the child upon the after-birth. 

HEMORRHAGE AFTER DELIVERY. 

It is expected there will be a certain amount of blood dis- 
charged after the expulsion of the contents of the womb. 
And it is not hurtful either, but may become so when it is 
excessive. This discharge of blood takes place from the 
mouth of the vessels, which may be exposed by the partial 
or entire separation of the after-birth. It seldom oecurs if 
an interval elapses between the expulsion of the head and 
body of the child, but more frequently after its birth, and 
before and after the expulsion of the after-birth. Hemorr- 
hage may also be caused by the presence of a clot, or poly- 
pus in the womb. After delivery the womb may not contract 
and hemorrhage ensues. 

SECONDARY HEMORRHAGE. 

Sometimes women lose large quantities of blood, eight or 
nine days after delivery ; to this the term of secondary he- 
morrhage is applied. 

CAUSES. 

The causes of this variety are many ; the retention of a 
portion of the after-birth, the removal of clots, the pains being 
insufficient to expel them, the relaxation of the uterine con- 
tractions within a limited period; local or general distur- 
bance of the circulation, constipation, polypus, inflammatory 
ulcerations, laceration. 

10 



110 PARTURITION OR LABOR. 

THE LOCHIA. 

After delivery, a discharge of blood follows which ema- 
nates from the mouths of the blood vessels left exposed by 
the detachment of the after-birth. After a while it changes 
its character, is no longer blood, but presents the character 
of a secretion. It is red for three or four days, but thinner, 
more water than blood, and is not coagulable, then it be- 
comes yellowish; frequently is of a serous consistence, 
but it changes its color to greenish, then yellowish, and finally 
to a solid water appearance. Its odor is peculiar. The du- 
ration of this discharge varies in different patients, the con- 
stitution having an influence over it. 

It may continue for a month, and may last but for a few 
days. With regard to the quantity it depends upon the 
extent of the secreting surface of the womb. The throwing 
of the lochia is a necessity as it conduces to the uterine 
health. I have known bad and serious effects to result from 
its sudden stoppage. 

THE MILK. 

During the process of gestation the breasts enlarge, and 
secrete a serous fluid, which immediately after child-birth 
and a number of days afterwards is called colostrum, be- 
cause of its viscidity. The colustrum posseses a laxative pro- 
perty, aids the expulsion of the moconium. As a general thing 
the breasts remain quiescent for about twenty-four hours after 
delivery. The child is nourished by the mother, so it sub- 
sists on its mothers milk, until after the development of the 
teeth. Now the milk is a secretion, and is eliminated from 
the blood in the mamma. Each mammary gland is composed 



PARTURITION OR LABOR. Ill 

of several lobes, which comprise lobules, and these, still 
smaller bodies or granules. 

I have known cases where the milk flowed from the 
breasts during the later period of pregnancy. 

As in many other things, there is a great variation in the 
nursing period of women. The habits of life have a good 
deal to do with it. Cases have happened in which two, and 
even three children of different births were nursed at the 
same breasts. The continuous application of the child to 
the breasts has a tendency to prolong the formation of milk, 
as the mammary gland of the cow becomes excited in the 
process of milking, so that milk is secreted even to the time 
of giving birth to another offspring. 

As the constituents of milk, we have the following : 
water, butter, caseine, sugar of milk, extractive matter, and 
fixed salts. There is no material difference between human 
milk, and that of other mammals in its leading constituents. 

THE QUANTITY AND QUALITY OF MILK. 

These are governed by severai conditions, such as the quan- 
tity, and quality of the mothers ingesta ; disease, medicines, 
and habits of living. The welfare of the child is highly de- 
pendent on the hygienic habits of the mother. There are too 
many stimulants and narcotics used by mothers ; as a rule 
they should be abstained from. As much as possible all sud- 
den and extensive emotions, such as excessive anger, joy, 
grief, should be avoided. 

During the nursing period, the breasts are channels for the 
elimination of all poisons from the body, such as opium, al- 
cohol, antimony, &c. These are too apt to be incorporated 



112 PARTURITION OR LABOR. 

with the milk, and mothers cannot be to particular in their 
use. 

LACTATION AND PKEONANCY. 

The liability of woman to conceive during lactation is very 
much less than at other times ; they are not, however, in- 
variably protected against pregnancy. The appearance of 
the menses is looked upon as an evidence that the reproduc- 
tive organs are competent to perform their functions; but 
menstruation may occur during lactation without hemorrhage, 
which may take place without menstruation, therefore we 
cannot regard this rule as invariable. And then the excep- 
tions to it are explained in this way : menstruation is simply 
ovulation, which sometimes takes place without hemorrhage. 
The question may be asked as it has been hundreds of times ; 
should the child be weaned, when menstruation is resum- 
ed? There has been a diversity of opinion on this point; 
it undoubtedly depends upon the circumstances of each in- 
dividual. This would be the proper course to adapt. If the 
normal condition generally existed, where we have the ces- 
sation of the mammary secretion r the recurrence of the process 
of ovulation, and considerable advance made in the mastica- 
tory organs of the child, all existing together, the question 
would need no reply ; but the reverse of this natural arrange- 
ment is . of so frequent occurence that it may be considered 
the actual rule, instead of being the occasional exception. 

Notwithstanding conception should not take place during 
lactation, as it is unnatural, so it is unreasonable to expect 
that the woman, while nursing one child, can. so perfectly 
develope the ovum of another. When properly viewed, there 
can be but one opinion, that many diseases that befall moth- 



SOME OF THE DIFFICULTIES OF CONFINEMENT. 113 

ers, and many infirmities, monstrosities met with in the 
offspring, are the dreadful effects of sexual indulgence during 
pregnancy. During the state of pregnancy, all the surplus 
vital force of the mother should be contributed toward the 
nourishment, and perfect development of the new being, 



CHAPTER II. 

SOME OF THE DIFFICULTIES OF CON- 
FINEMENT. 

PUERPERAL MANIA. 

While the female is liable to suffer from attacks of puer- 
peral mania, either during gestation or parturition, she is 
however, more liable to it just a few days after delivery. 
It is an affection of the most distressing nature. When we 
seek to find out its origin, we discover that it is dependent 
upon debility, the patient suffering from flooding during her 
labor, or upon the presence of some morbid poisons, in the 
system which is acting as a depressent to the vital powers. 
Frequently the delirium is very great, and the patient may 
make some attempts to commit suicide. 

SYMPTOMS. 

In some cases we have fever, hot, dry skin, the pulse full 
and quick, tongue furred. 

CAUSES. 

It is generally supposed to be hereditary, and the patient 
rendered more liable to an attack by mental deviations during 



114 SOME OF THE DIFFICULTIES OF CONFINEMENT. 

gestation ; excessive loss of blood, producing an anemia of 
the brain ; sleeplessness, cold, irritation, irregularities in diet, 
distress of mind, mental shocks, disordered bowels, excessive 
secretion of milk, nervous debility. 

PUERPERAL CONVULSIONS. 

HTSTEKIC CONVULSIONS. 

We find this variety, as a general thing, attacking patients 
during gestation, occuring more frequently in the early 
months, and usually with those of a nervous sanguine tem- 
perament 

CAUSES. 

Beyond all question it is a disease of a nervous character, 
and consists of an erethism of the entire nervous system, 
and any exciting cause is liable to bring it in activity ; sleep 
fatigue disordered digestion, mental emotions and the like. 

symptoms. 

Those symptoms which are generally the forerunners of this 
disease are as follows: flatulency, pains, distressing sensa- 
tions in the stomach, bowels, chest, head, sense of suffocation, 
from something like a ball rising in the throat, sobbing, re 
peated attemps at swallowing. At this time the patient be- 
comes still, and motionless, or may seem somewhat uneasy, 
and rolls from one side to the other. She frequently presses 
her hands upon her breast or neck, as if she were desirous 
of removing some obstruction. If the woman be of a true 
nervous temperament, some delirium, and loss of consciousness, 
will be present ; pale, undistorted face ; no froth from the 



SOME OF THE DIFFICULTIES OF CONFINEMENT. 115 

mouth, the lower jaw will exhibit no convulsive motions, 
neither does she bite her tongue. If the patient be of a 
nervo-sanguine temperament, in an attack of hysteria, their 
will be some twitching of the muscles of the mouth and eyes ; 
convulsive laughing, crying, sobbing ; she will make frequent- 
ly attempts to pull her hair, strike her breast or bite ; respira- 
will be laborious, she sheds tears, and screams, with which 
the fit terminates. She passes a large quantity of urine, 
which is very transparent. 

EPILEPTIC CONVULSIONS. 

A patient attacked with an epileptic convulsion, may from 
all appearances, be in her usual good health, and it comes 
on with the following. 

PREMONITORY SYMPTOMS. 

Spectral illusions, headache, sickness, giddiness, dimness of 
vision, confusion of thought, a sense of fear, a strange sen- 
sation, compared by the patient to a stream of cold water, or a 
current of cold, or warm air. Before very long there is a 
subsidence of the symptoms, and for a little while there is 
some jerking out of the extremities of one side, but soon all 
these cease. The patient is left insensible, and from every 
appearance in a profound sleep ; from this she finally recovers 
exhausted, and with a headache, but she does not know she 
has passed through what she has. There is a difference in the 
duration of an attack, but the average duration is from five 
to eight minutes ; some cases, however, have lasted half an 
hour. The interval between the attacks may be two or three 
months, but as the disease goes on, the intervals may become 
shorter. There is a great danger of the mental faculties be- 



116 SOME OF THE DIFFICULTIES OF CONFINEMENT. 

coming impaired, and bringing on temporary or permanent 
paralysis. During the fit the following 

SYMPTOMS. 

Are present; nashing of the teeth, foaming at the mouth, 
tongue thrust out, and sometimes severely bitten ; the eye 
balls rolling, pupils insensible to light ; skin cold and clam- 
my ; involuntary passages from the bowels and bladder with 
vomiting ; breathing laborious or suspended ; the face turgid 
and distorted. 

CAUSES. 

It will not be doubted, that this disease is often here- 
ditary. 

The predisposing causes are malformations of the head. 
Frequently they are dependent upon a loaded condition of the 
brain ; at other times the brain is influenced by distant irri- 
tation in the womb or digestive organs ; excesses, fright, 
blows on the head, insanity &c. 

PUERPERAL EPILEPSY. 

The various writers have divided epilepsy into two varie- 
ties; idiopathic, and symptomatic. 

IDIOPATHIC EPILEPSY. 

This variety is produced by external causes, forcible com- 
pression of the head, contusions, fractures ; a defective or- 
ganization of the cranium, lesions of the meninges of the 
brain, or serous or sanguineous extravasation into the cavity 
of the skull ; nervous affections produced by moral affections 
of the mother, nurse or patient. 



SOME OF THE DIFFICULTIES OF CONFINEMENT. 117 

SYMPTOMATIC EPILEPSY. 

This variety is connected with the digestive organs, de- 
rangements of the arterial system, from suspension of the 
menses, habitual hemorrhage, syphilis, gout ; or its connec- 
tion with the organs of reproduction, excited by venereal ex- 
cesses, masterbation, pregnancy, delivery, excited by irri- 
tation. 

Although congestion of the brain is not the cause of the 
paroxysm, yet we have it in all cases of epilepsy. In those 
cases that have proved fatal, a post mortum has discovered 
distention of the membranes of the brain. 

APOPLECTIC CONVULSIONS. 

This variety of convulsion is rarely met with, except about 
the termination, or after labor. 

CAUSES. 

Full habit, stress upon the cerebral vessels during the 
labor pains. 

SYMPTOMS. 

For some time before labor, we hear the patient complain- 
ing of a throbbing sensation in the head ; she is apt to com- 
plain of headache, the face may be flushed, eyes injected, 
there is but little convulsion, the body and extremities are 
agitated, and the patient lies in a comatose condition. In a 
case of this kind there may be no distortion of the features, no 
frothing at the mouth, the breathing is usually stertorous. 
The pupils of the eyes are in some cases dilated, contracted 
in others, but in all cases insensible to light. 



118 SOME OF THE DIFFICULTIES OF CONFINEMENT. 

CHOREA. 

This disease as a general thing happens with females of 
feeble constitutions, and of an irritable, nervous temperament. 
If we find a patient having irregular, tremulous, and some- 
times ludicrous actions of the muscles of the face, and limbs 
during the waking state, we may recognize a case of chorea. 
The young are the most susceptible to this desease, also 
those of sanguineous temperament. 

CAUSES. 

Those women who are naturally delicate, and whose con- 
stitutions have been impaired by the use of medicines, are the 
ones in whom chorea is the most readily produced. The most 
frequent cause is supposed to be the repression of cutaneous 
eruptions. The depressing passions, fear, terror, masterba- 
tion irritation of the bowels, cold, insufficient nourishment, 
excessive loss of blood. 

SYMPTOMS. 

Chorea may be either of a mild or severe type. Its com- 
mencement is characterized by twitchings of the muscles of 
the face, and finally all of the voluntary muscles are affected, 
twisted and contorted features, impeded articulation ; if she 
is asked to put out her tongue, she is unable to do so for 
some time, and then thrusts it out, and quickly withdraws 
it ; ask her to walk, and she proceeds in a jumping manner, 
loj fits and starts, dragging her limbs, rather than lifting them, 
and alternately halting, and hopping, she can not sit still, 
lier shoulders move, she kicks her dress, scrapes the floor 
with her feet. The intellect is apt to become impaired, should 



PUERPERAL FEVER. 119 

the disease last long ; the patient looks at you with a vacant 
stare, and expression of fatuity. There is a derangement of 
the functions of the stomach and bowels, appetite irregular 
abdomen swollen and hard, sometimes constipation. 



CHAPTER III. 

PUERPERAL FEVER. 

This term has been applied to various states, happening 
after delivery has taken place. 

Their are two forms of puerperal fever, the sporadic and 
epidemic. The first variety, as a general thing, is mild, 
and the patient recovers. The other variety is of a more dan- 
gerous character, and often terminates in death. The time 
at which this disease exhibits itself is at from five to ten days 
after delivery. 

SYMPTOMS. 

A chillis the first symptom that generally manifests itself; 
sometimes this is very great, at others it is slight, amounting 
to a mere rigor, and continues to recur throughout the fever, 
sometimes with great regularity, at others irregularly, but 
once or more in twenty-four hours. The skin is hot, and 
often accompanied with a profuse perspiration, the latter oc- 
curing at night when the patient falls asleep. At the com- 
mencement of the disease, the tongue is coated with a white 
fur; subsequently it becomes dry, red, and coated with a 
dark layer, or is clean, red, dry, chapped. There is thirst 
at first, but as a usual thing subsides in a few days. She is 
able to eat but little or nothing, the appetite being almost 



120 PUERPERAL FEVER. 

absent. There is a rapid pulse, ranging from 120 to 200° in 
a minute, but usually soft and easily compressed. We have 
a deranged nervous system, the patient suffering from wake- 
fulness, despondency and apprehensions, she starts and talks 
in her sleep, slight delirium supervenes, but when aroused 
talks incoherently. In some cases stupidity is present, and 
we hear her muttering, moaning, and working the muscles of 
the face. As a general thing the stomach is not much af- 
fected, there being no nausea and vomiting. The bowels are 
deranged in most of cases, diarrhea being a common symp- 
tom, the stools thin, dark colored and offensive. There is 
some distension of the abdomen from gas, and some tympany. 
The intestines, in bad and fatal cases are considerably dis- 
tended, there is not much pain, but slight soreness over 
and about the region of the womb. The pains are sometimes 
of a neuralgic nature, situated in the shoulders, arm and 
head. 

For several days the discharge, and the milk flow freely ; 
but gradually become less, and finally are suspended, the 
discharge is fetid, offensive and putrefactive. 

CAUSES. 

Puerperal fever is due to absorption of the products of de- 
composition. Sometimes portions of after-birth, and mem- 
branes are retained within the cavity of the womb, for so 
long a time that decomposition is the result ; the system ab- 
sorbs its poisonous products giving rise to puerperal fever. 
At other times the contractions of the womb are quite insuffi- 
cient, hence we have accumulation of blood, which remains 
until it becomes putrid, thus furnishing material for absorp- 
tion and poison. This is its origin in the sporadic variety. 



PUERPERAL FEVER. 121 

When puerperal fever prevails as an epidemic, we have 
a predisposing cause operating upon the whole co mmunity. 

PUERPERAL METRO-PERITONITIS. 

This disease, like puerperal fever, takes place sporadically 
and epidemically. 

SYMPTOMS. 

In many instances this affection occurs without any pre- 
monitory symptoms, beyond pain in the hypogastric region, 
or lower part of the abdomen, and tenderness on pressure. 
Generally about forty-eight hours after delivery, we have 
chilliness, and coldness supervenes, nausea and vomiting are 
present. After the disease is fully established, we have 
fever, pain, tenderness, and enlargement of the abdomen. 
The region of the womb is where the tenderness and pain are 
confined at first, but finally the whole abdomen becomes in- 
volved. G-as accumulates in the intestines, in consequence 
of which the abdomen becomes tympanitic. The pulse is very 
rapid, ranging from 120 to 150°, and small, wiry and 
weak. The tongue is coated, moist and may become dry, 
brown and even dark. Dark sordes cover the teeth. After 
a few days have elapsed, the fever takes on a heptic type, and 
abscesses form. 

CAUSES. 

These are various ; injuries caused by producing abortion, 
the effects of drastic medicines, excitement from passion, al- 
coholic stimulants, are sometimes the causes of the disease, 
as also cold taken during delivery, with long and severe 

labor. 

11 



122 SUDDEN DEATH OF THE MOTHER AFTER LABOR. 

When puerperal metro-peritonitis appears as an epidemic r 
the causes just enumerated have no influence in its perpet- 
uation, but it depends entirely upon an epidemic influence, 
pervading the atmosphere ; but taking it for granted that 
this epidemic influence does not exist, the physician may 
carry it from one to another by his own hands. 

Sometimes there is a prevalence in communities of erysipe- 
las, putrid angina, scarlet fever, typhus fever, and it is at 
this time that metro-peritonitis makes its appearance. 



CHAPTER IV. 

SUDDEN DEATH OF THE MOTHER AFTER 
LABOR. 

It must be sad in the extreme, for the physician to witness 
the sudden death of a patient after having given birth to her 
offspring. But the occurrence is rendered, the more melan- 
choly by the fact of her being in good health in every other 
respect, and having passed through the whole nine months 
of pregnancy bearing the sickness, inconveniences, and an- 
xiety peculiar to such a state, and having passed through the 
process of labor with its perils and agonizing pains, and being 
delivered of her child. Nevertheless this is sometimes the case, 
and most of physicians of long experience have been called to 
pass through such a scene sometime in their history ; though 
I thank God that no such accident has ever befallen myself, 
and I trust never will. 

In consequence of the extreme suddenness of such an event, 
many times the physician is unable to use means of treatment.. 



SUDDEN DEATH OF THE MOTHER AFTER LABOR. 123 

In view of the possibility of such an accident, the parturient 
patient should be very particular as to making any exertion 
after the accomplishment of labor. 

CAUSES. 

These are various, and demand a separate consideration. 

SYNCOPE. 

This is frequently the cause of sudden death to the mother. 

Such a state does not so much depend upon hemorrhage, shock 

or fear, but in the majority of cases is traceable to cardiac 

paralysis. 

ASPHYXIA. 

In many cases asphyxia causes almost instantaneous death. 
It resembles very much fatal syncope, and is thought by some 
to be a variety of it. After labor, from the condition in 
which the constitution of the woman is left, she is rather sus- 
ceptible to diseased action, and liable to the invasion of 
asphyxia. Asphyxia is characterized by fainting placidity 
of the heart with a want of blood in its cavity. 

CAUSES. 

Pains of long duration, and of great intensity, great ner- 
vous shock from a severe and protracted parturition, the ab- 
sorption of air into the uterine sinuses ; the penetration of the 
air into the vena cava from the veins of the womb ; the for- 
mation of a fibrinous clot in the heart These with other 
things have been considered the causes of sudden death. 

EMBOLISM. 

During a state of pregnancy as well as other conditions, 
there is thought to be a large excess of fibrine in the blood, and 



124 SUDDEN DEATH OF THE MOTHER AFTER LABOR. 

when there is any obstacle to the normal circulation, as 
pressure of the impregnated womb, fibrinous formations are 
apt to take place in the arteries, veins, cerebral sinuses, and 
heart. There is a certain condition of the blood during preg- 
nancy, and the period of child-birth which very much favors 
the formation of these masses. Sometimes the fibrinous clots 
form suddenly, and the patient dies at once from the obstruc- 
tion of the circulation. At other times masses form and be- 
come attached to the walls of the heart, or carried by the 
blood, blocking up the circulation at some extreme point. 

symptoms. 

Supposing the clot is in the heart, we have an interruption 
of the circulation, the aration of the blood is impeded in the 
lungs, at the same time, there is an imperfect supply to the 
brain. 

Parturient women who die suddenly are affected with clotty 
blood. Death from coma or syncope, results from the ob- 
struction of the circulation, by the situation of the clot in the 
left cavity of the heart or aorta. 

HEART DISEASE. 

Some patients may have organic disease of the heart, and 
if so, there is an arrest of the circulation, and congestion 
follows, caused by a disturbed circulation. She may have 
general dropsy, and die soon after delivery. 

Sudden death may occur from a very small perforation of the 
ntestines. 

The patient may die suddenly from an attack of scarlet fever. 



PART III. 
DISEASES OF WOMEN. 



CHAPTER I. 

DISEASES OF THE BREASTS. 

There is a great variety of diseases that are liable to effect 
the breasts of woman. They may be either acute or chronic, 
and always attended with more or less inconvenience and 
suffering. Some of the diseases thus attacking the breasts 
of women, are of a mild character, and of comparative in- 
significance ; others are of a very grave nature, the patient 
undergoing a great deal of physical and mental suffering, 
involving her general health, and baffling the skill of the 
most skillful and emminent physicians in the country. 

INFLAMMATION OF THE BREASTS. 

This affection is frequently met with in pregnant and nurs- 
ing women. It usually comes on during the time when the 
mamma are functionally active. It may be either acute or 
chronic. The parts of the breasts usually attacked, are the 
tissues in and around the breasts, as the skin and integuments, 



126 DISEASES OF THE BREASTS. 

areolar, glands, follicles, fascia ; the lymphatic glands, su- 
perficial or deepseated, and structures that enter more inti- 
mately and essentially into their formation, the milk ducts 
or the subareolar expansion of the milk tubes, milk reser- 
voirs, and the lactael glands and cellular tissue which per- 
vades it. 

CAUSES. 

One probable cause is allowing the breasts to become dis- 
tended with milk, as is often the case in sore nipples, and 
with those mothers who remain long at balls, parties, theatres, 
leaving their little sucklings at the mercy of others to do the 
best they can. 

But the positive causes are cold, irritation, injury, poor 
diet, and sympathy with gastric, intestinal, heptic, uterine 
or renal irritation &c. 

INFLAMMATION OF THE NIPPLE. 

This generally shows itself in the form of an abrasion, crack, 
and ulceration. Most frequently an abrasion is seen in the apex 
of the nipple, and the gums and teeth in nursing remove the 
delicate epidermis, leaving the dermis naked, bleeding and 
raw. In almost every case these cracks or fissures lead to 
ulceration. In the beginning of lactation is when this condi- 
tion commences. 

SYMPTOMS. 

Small ulcerations occasionally are seen on the areola, but 
more frequently on the nipple; acute pain, and impaired 
general health, dread, mental depression, loss of appetite, 
restless nights. 



DISEASES OF THE BREASTS. 127 

INFLAMMATION OF THE LYMPHATIC GLANDS 
OF THE MAMMA. 

The inflammation of the lymphatic glands occur often, and 
is in consequence of the passage of acrid or unhealthy lymph 
through them, being derived from inflamed tissue. 

MAMMITIS. 

By this is meant an inflammation of the breasts which may 
be either an acute or chronic condition. It usually takes 
place during lactation. 

CAUSES. 

Cold, irritation of sore nipples, external injury, poor diet, 
general debility, sympathy from gastric, intestinal, hepatic, 
uterine, ovarian or renal irritation. 

SYMPTOMS. 

Severe pain, swelling, hardness, shivering, fever, quick 
pulse, coated tongue, delirium, secretion of milk, suppura- 
tion, characterize the acute form. Enlargements of the 
glands, hardness and usually suppuration are symptomatic of 
the chronic form. Those patients of a scrofulous diathesis, are 
most liable to it. 

ABSCESS OF THE MAMMA. 

Abscesses may form within the substance of the gland it- 
self, or between the gland and the skin, or between the 
gland and walls of the chest. They are either acute or 

chronic. 

symptoms. 

Iligors, congestion of the breast, burning pain, deep seated, 
throbbing, sense of weight, formation of a painful faint, and 
finally softness and fluctuation. This is the acute form. 



128 DISEASES OF THE BRBA8T8. 

A chronic abscess is at first recognized by an induration 
or hardness of the gland, soreness about the nipple, the tu- 
mors and skin adhere, matter forms slowly. This condition 
of things is dependent upon a scrofulous habit, and a de- 
ranged general health, taking place usually in puerperal 
women. 

CAUSES. 

The susceptibility of some women is much greater than 
that of others, and abscesses are much more apt to form in 
the former than in the latter. The principle cause is conges- 
tion, it may accompany lactation or congestion from sexual 
intercourse in nursing women of very excitable temperaments. 
Other causes are cold, sore and undeveloped nipples, irrita- 
tion from the use of stays, bruises, blows. 

MASTODYNIA. 

By this is meant neuralgia of the breast. It is a very com- 
mon affection, and we find it taking place without any 
disease of the gland structure. Sterile woman, married or 
single, are the most susceptible to this variety of neuralgia. 
The period of menstruation, as a general thing, has a ten- 
dency to aggravate it, pregnancy is thought to be its origin* 
We find it attacking most frequently, those women of a ner- 
vous temperament, or those who are subject to the irregu- 
larities, as well as those of broken down constitutions. 

Usually only one breast itf affected, and that is the left one, 
but sometimes both are affected at the same time. 

SYMPTOMS. 

There is considerable heat and swelling in the affected 
breast. The pain is of a wearing aching character, confined 



DISEASES OF THE BREASTS. 129 

to the breast of variable intensity, comes and goes period- 
ically, running to the shoulders, under the arm and down the 
side. There is also loss of appetite, restlessness and anxiety. 
The patient is liable to recover all right, unless the disease 
occurs as the sequel of some fatal disease, such as cancer. 

MAMMARY HYPERTROPHY. 

By this is to be understood the enlargement of the breast. 
Enlargement of one or both breasts is sometimes met with. 
As a general thing, we find one gland affected first, the 
other following, the enlargement gradually and steadily in- 
creasing . Under such a condition the functions of the womb 
are always imperfect, and the general health impaired. In 
almost every case masterbation is the cause. 

Mammary hypertrophy is a very difficult disease to treat, 
and usually the physician has but little satisfaction in attend- 
ing such a case. 

MAMMARY TUMORS. 

It is an astonishing fact, except to physicians, and those 
who have made it a matter of investigation, that the female 
breast is the seat of so large a variety of tumors. 

These tumors appear either in a simple or malignant form . 
The most common tumor met with in the breast is that known 
as the lacteal or milk tumor, occuring during lactation. 

SYMPTOMS. 

An elastic fluctuating tumor varying in size from a small 
apple to an orange. As the watery portion of the milk be- 
comes absorbed, the tumor gets firm and solid. Usually the 



130 DISEASES OF THE BREASTS. 

tumor is discovered by mere accident. The health is gener- 
ally good. 

MUCOUS CYSTS. 

By mucous cysts is meant, the gland ducts being dilated, 
and expanded with mucus and epithelium. These cysts may 
be but one or several in number in the one breast ; there 
Tiave been found in the breast masses of fat, cartilaginous 
and bony tumors. 

GLANDULAR TUMORS. 

Women are subject to the growth of tumors which usually 
commence from the age of fifteen to thirty, growing slowly, 
and finally become of an astonishing size, remaining station- 
ary for an indefinite period of time, and then rapidly in- 
creasing in size ; in some cases it may diminish, but rarely 
disappears entirely. 

SYMPTOMS. 

This variety of tumor commences quite small, and is 
movable, nodulated, appearing isolated from the tissue of the 
^land. If there is pain at all, it is inconsiderable; the skin 
is not involved. As the tumor continues to grow, the breast 
is apt to diminish ; the rate of growth varies. If it should be 
large, the skin is likely to ulcerate and the growth protrudes. 

CAUSES. 

This, like many other growths or tumors, frequently re- 
sults from some mechanical violence and irritation. 

AGALACTIA. 

This implies an absence of the secretion of milk. 



DISEASES OF THE BREASTS. 131 

There are two forms of this condition we meet with ; first the 
milk failing to make its appearance after parturition ; secondly 
when it ceases to be secreted during the period of lactation. 

This disease is often stubborn, and difficult to remedy, and 
of course where the glands are deficient it is incurable. It is 
often very abstinate where a patient bears children in ad- 
vanced life. 

CAUSES. 

Deficiency in the formation of the gland, inflammation or in- 
jury as the result of accident ; depressing mental passions, 
cold and the like. 

GALACTORRHEA. 

When a woman, while nursing, has an unusal quantity of 
milk ; when the flow is so excessive that the patient is weakned 
by it, we call it galactorrhea. Sometimes the flow of milk 
is so great that the general health of the woman is more or 
less affected. 

CAUSES. 

Debility, diseases of the womb, indigestion, and a general 
morbid condition. 

CANCER OF THE BREAST. 

There is no disease to which the human family is subject, 
more distressing than cancer. It has given rise to a great 
amount of quackery, and imposition by ignorant pretenders, 
many poor sufferers having been subjected to the painful ac- 
tion of caustics, swindled out of their money and in the 
end met with sad and bitter disappointment. 



132 DISEASES OF THE BREASTS. 

Cancer is very frequently found among females, expecially 
those at the turn of life, and although it attacks the various 
female organs, yet the breast is the most common seat of the 
disease. 

Cancer of the breast is usually divided into three varieties, 
namely, scirrhus, medullary and colloid. 

Cancer is met with in all parts of the breast, but most com- 
monly in the gland. 

SYMPTOMS. 

The patient does not experience much pain at an early 
period of the disease. But what is felt is of a sharp, darting 
lancinating character, and comes on in paroxysms ; bnt after 
a while the character of the pain is materially changed, Br 
gnawing and burning is realized. 

The scirrhus form of the disease we find making its appear- 
ance as a small or large lump, deeply seated or near the sur- 
face of the skin. The skin around it, adheres, and its color is 
gradually changed until it becomes a purple, it becomes hard 
aud resisting to the touch, the skin ulcerates, and a foul, 
irregular, rough-edged, fetid excavation occupies the outer 
part of the tumor, and has a peculiar smell. 

The medullary variety is not so hard, but is soft and 
yielding to the touch, and as it comes near the surface the 
softness is more marked, points press the skin outwards, and 
becomes purple and soon gives away. 

Finally after a rapid course, the disease bursts out into a 
bloody fungus, which leaves the surface, becomes detached 
in sloughs, and throws off a fetid discharge. 

Cancer is undoubtedly a blood disease, and when met with in 
the female breast, is but a local manifestation of the blood 



MATERNAL STOMATETIS OR NURSING SORE MOUTH. 138 

diathesis. The skin has a dirty yellow appearance, the fea- 
tures contracted, wasting, loss of strength and energy, men- 
tal irritability. 



CHAPTER II. 

MATERNAL STOMATITIS OR NURSING 
SORB MOUTH". 

Women who are about to become mothers, or those who 
are nursing, are liable to be affected with painful inflammation 
of the lining membrane of the mouth, which is commonly 
known as nursing sore mouth. 

The most robust as well as the most sickly are not exempt 
from it, but those of costive habits, and dispeptic symptoms 
seem to be more obnoxious to its attacks than others. 

Inflammation of the mouth is thought to be a mere symptom 
of the condition of a general constitution of the whole system, 
a morbid condition of the blood. 

We have several varieties of the disease, each depending 
upon the intensity of the morbid condition present, and being 
merely grades of one constitutional disorder. 

SYMPTOMS. 

As a general thing the disease comes on suddenlv. The 
first symptoms are a severe scalding of the tongue, with pain. 
The tongue and roof of the mouth assume a pink color, and 
there is a profuse watery discharge from the mouth, being 
very hot, so much so as to give a scalding sensation to the 
face in passing over it. If the patient takes food or drink 

12 



"lo-A DISEASES OF THE LABIA, ETC. 

into the mouth, she experiences more or less pain. After the 
lapse of a few days, we find ulcerations about the tongue and 
throat manifesting themselves, which are accompanied by a 
scalding flow of saliva, pain and other symptoms, and con- 
tinuing until the child is weaned, or the patient is cured. 
Usually the bowels are costive. Sometimes the disease in- 
vades the bowels, when diarrhea follows, and the case is 
rendered much more dangerous. Although weaning is not 
always necessary yet the disease disappears when the child is 
weaned. There is a disposition to a return of the disease at 
each subsequent delivery, but this disposition is diminished 
where a cure has been effected while the child is nursing. 
It has proved fatal in from three to six weeks after the birth 
of the child; sometimes, however, the patient has several 
attacks before it results in death. 



CHAPTER III. 

DISEASES OF THE LABIA, PERINEtM 
AND VULVA. 

ADHESION OF THE LABIA. 

Sometimes the physician is called upon to treat cases of 
this kind, which occur in infancy and childhood as well as in 
adult age. Usually the adhesion of infancy is of an insignifi- 
cant nature, being nothing more than the coaptation of the 
sides of the mucous membrane, and consequently is not dif- 
ficult to remedy. 

Adhesion of a more serious nature, and consequently more* 
difficult to treat is to be found in adult persons. In such cases 



DISEASES OK THM LABIA, ETC. 185 

fchey are fche result of inflammation, occuring during childhoo I, 
and very often involving the entire vaginal cavity. 

WOUNDS. 

Sometimes the labia are wounded by accidents of a foreign 
nature, and at other times they are lacerated during the pro- 
cess of labor. The wound may be so great as to cause alarming 
and sometimes fatal hemorrhage, and in or<]er that the hemor- 
rhage might be arrested before a serious result, the skill and 
prompt interference of the physician is required. 

SANGUINEOUS INFILTERATIOX. 

While the process of labor is going on, and the parts being 
stretched to their very utmost, some of the anterior twigs 
give way, and the blood from these vessels is forced in the 
loose structure of the labia. If this infilteration should be in 
the second stage of parturition, it is usually very great, but 
with proper treatment it rarely becomes serious. 

ABSCESS OF THE LABIA. 

We have three different forms of abscess affecting the 
labia. They are as follows : first the common phlegmonous 
inflammation which affects the centre of one labia. It is char- 
acterized by swelling, heat, pain, &c. Sometimes these art- 
great, the inflammation running its course very rapidly, suppu- 
rating and discharging in a few days. Bruises, acrid dis- 
charges from the vagina, and the like are the causes of this 
variety of the disease. 

The second form has its origin in the overdistention of an im- 
portant gland, from a stoppage of its excreta'ry duct. There 



136 DISEASES OF THE LABIA, ETC. 

is a good deal of slowness in the progress of this form, and 
is also less tender to the touch. 

In the third variety small boils show themselves in hard 
points under the mucous membrane of the skin, and are very 
tender and suppurate at an early period. It is supposed that 
they depend upon a dyspeptic, anemic, state of the system. 

RUPTURE OE THE PERINEUM. 

Both the perineum and labia are liable to be ruptured dur- 
ing the process of labor, and in fact such an accident has 
sometimes occured with the most dexterous accoucheur. 

CAUSES. 

In some women the sacrum is comparatively straight, 
which may cause rupture of the perineum by allowing the 
child's head to emerge from the pelvis further back than is 
commonly the case. Rigidity of the perineum, an undilatable 
state of the external organs, as is usually the case *with the 
primipara old women, a large and unyielding head, unnatural 
position, and the unskillful use of the forceps. The latter 
cause we can safely say, is the most common of all the rest. 
And the reason of it is, the operator fails to make the proper 
spiral change in the position of the child's head, so that the 
back part of the head will be brought under the arch of the 
symphysis ; in not keeping the back part of the head close to 
the symphysis by properly raising the handles, in making 
too powerful traction, and letting the instruments to slip. 

As to the extent of perineal rupture, it may be a simple 
laceration or a complete rupture of the sphincter ani. 

Such an accident very often occasions a good deal of dis- 
tress, particularly if it is a complete rupture, for in such a 



DISEASES OF THE LABIA, ETC 137 

case there are involuntary discharges from the rectum, and as 
result of this we have other symptoms, such as an inflamed 
and excoriated mucous membrane of the vagina, caused by 
contact with the feces. 

LACERATION OF THE PERINEUM. 

Usually there are three varieties of perineral laceration . 
First, simple laceration of the skin from the fourchette to- 
ward the anus. Second, division of the areolar tissue, su- 
perficial perineal fascia, and fibres on the constrictor vaginal 
muscle. 

Third, laceration of the recto-vaginal septum, with more or 
less division of the constrictor, vagina and sphincter ani mus- 
cles . 

The first and second varieties are not of such a serious 
character, for a cure can easily and readily be effected by 
bringing the edges in apposition, and by keeping the limbs 
together for several days. But the third variety is rather a 
serious accident. The patient is unable to control the rectum, 
gas and feces involuntary escaping, persistent and serious 
diarrhea ; inflammation and excoriation of the vaginal surface, 
which symptoms taken altogether, tend to make the woman 
disgusting to herself and a burden to her friends, 

CAUSES. 

Mechanical injury, as a fall upon the edge of a stool, or 
any thing that would have the same effect. But the most 
common cause is labor, laceration, happening in consequence 
of the accoucheur not supporting the perineum or improperly 
applying the forceps. 



138 DISEASES OF THE VULVA. 

CHAPTER IV. 
DISEASES OF THE VULVA. 

The vulva is the seat of quite a variety of skin diseases, 
such as erythematous, papular, vesicular and pestular inflam- 
mation. There is however, a distinct disease, which attacks 
the vulva, called 

PURULENT VULVITIS. 

This affection is characterized by severe inflammation of the 
mucous membrane of the vulva. It has very small ulcerated 
points, in number from one to two dozen. These ulcerations 
are about the eighth of an inch in diameter. There is intense 
redness, pain, swelling, the inflammation spreads very rapidly 
and a profuse discharge of pus and mucous from the cavity 
supervenes. Fever is present. The symptoms resemble very 
much those symptoms peculiar to gonorrhea. The disease 
seems to originate in uncleanliness, or in something that may 
be accidently applied, and causes irritation. Females of all 
ages are subject to attacks of purulent vulvitis, but more com- 
monly does it affect those from two to fifteen years, and if not 
properly treated is likely give a good deal of inconvenience 
and distress to the patient * 

GANGRENOUS VULVITIS. 

This is a very troublesome and obstinate, as well as a very 
severe disease, and is peculiar to the genital organs of the 
female. The first manifestation is seen in the form of a Wis- 



DISEASES Ol THE VULA A. 139 

ier on the side of the labia, which after a little while enlar- 
ges, becomes hard, tender and painful. Finally the blister 
breakes, and discharges an acrid serum which has a peculiar 
odor? The labia becomes hard, swollen, and in a very short 
time, say two or three days, gangrene of the part sets in. 

The disease is quite rapid in its course ; it powerfully de- 
presses the vital powers. 

When it appears in the sporadic form it is usually mild, but 
in the epidemic form it is very fatal. 

CONSTITUTION A L S V MPTOMS. 

Quick, feeble pulse, nervousness, restlessness or stupidity, 
extremities cold, tongue furred, skin dingy and sallow, and as 
the disease progresses, these symptoms become aggravated. 

PRURITUS PUDENDL 

This disease is characterized by an almost intolerable itching 
of the vulva. It comes on in paroxysms. It may not give 
the female any annoyance except when she approaches the fire, 
or she is heated by passion, exercise, before the menstrual flow, 
or during pregnane} r . 

SYMPTOMS. 

There is a burning sensation, and a desire irresistible, to 
scratch', though at many times it may be very indelicate, yet 
the patient can not refrain from doing so. Sometimes she 
may feel as though there were thousands of animalcules mov- 
ing upon her person. It does not only affect the labia, but 
pervades the entire organ. It is the result of some disorder. 



140 DISEASES OF THE VULVA. 

URETHRAL EXCRESCENCES OR GROWTHS. 

These growths at the opening of the urethral canal, emanate 
from the mucous membrane of the vulva, immediately around 
the urethra, or from the urethra itself. In some cases there 
is but one, and in others there are several y some resembling 
a fold of mucous membrane, others have the form of polypi. 
Their size is from a pins head to a small nut, in appearance 
some being red, scarlet, soft, and easily broken. Some- 
times they are large and very painful. There is great pain 
experienced in voiding the urine. 

ACUTE VAGINITIS. 

This is a disease of the vagina, which usually commences 
in the lower part of the vaginal canal. It is characterized by 
swelling, redness and dryness of the vagina, heat, burning 
pain, and difficulty experienced in passing the urine, pain in 
the movement of the bowels, weight in the pelvis, pain in 
the back, pain running down the thighs, hips, spine, head, 
with fever, chill alternating with heat, increased arterial ex- 
citement, furred tongue. In about thirty six hours the inflam- 
mation has involved the entire vagina, and soon afterwards a 
secretion of a green mucous supervenes. After this condition 
has lasted about three weeks, the inflammation subsides, the 
discharge becomes less, and color lighter, and at the end of 
the fourth week or thereabouts, the disease runs into a chronic 
form. 

CHRONIC VAGINITIS. 

The chronic form of this disease is much more common 
than the acute, and is attended with a irood deal more distress. 



DISEASES OF THE VULVA. 141 



SYMPTOMS. 



We have pain in the back, sacrum, coccyx and groin, a 
weight and a sense of bearing down in the perineum, drag- 
ging in the hips and pelvis, burning sensation in the vagina. 
Should the patient be married, the act of coition will very 
frequently cause great distress. There is always a white or 
yellow disci) arge from the vagina. 



SYMPATHETIC SYMPTOMS. 



There is nervous irritation, the mind is morose, headache, 
weak eyes, deranged stomach, arrested secretions. 

CAUSE. 

This form of vaginitis often follows as a sequel of an acute 
attack. It also follows gonorrhea, abortions, colds, consti- 
pation, scrofula and rheumatism. 

PUERPERAL VAGINITIS. 

By this is meant inflammation of the vagina, and usually 
takes place after labor. Of course it does not occur in all 
■cases of parturition, but there are some cases in which cir- 
cumstances will induce inflammation of the vagina . « 

SYMPTOMS. 

Usually the labia and walls of the vagina become swollen, 
hot and tender. Should there not be so much pain, the pa- 
tient will experience a sense of heat, fever, chilliness, distur- 
bance of the circulation ; there is the coated tongue ; a fetid 
■discharge of mucous and pus, tongue dry, sordes on the teeth, 
skin coverd with a clammy sweat. 



142 DISEASES OF THE VULVA. 

CAUSES. 

The child's head being long detained in the pelvis at the 
time of labor, will cause vaginal inflammation or puerperal 
vaginitis. The pressure upon the walls of the vagina inter- 
feres with the circulation. The use of instruments is some- 
times the cause of the disease. 

VESICO-VAGINAL FISTULA. 

By this is meant an opening through the vaginal walls into 
the urinary organs. In most cases the fistula or opening is 
at the base of the bladder, where it rests on the vagina ; 
sometimes, however, it is higher up. Such a condition gives 
the patient a good deal of distress and inconvenience from 
the fact that the urine, to a greater or less extent, passes 
through this opening instead of passing through the natural 
cannal, and she has no control over it; in view of which 
fact, in connection with others, the woman is renderd mis- 
erable. 

In regard to the extent of the vesico- vaginal fistula, it 
varies ; in some instances it is so small as to permit the urine 
to pass in small quantities, in others, the opening is so large 
as that considerable quantities of water are allowed to escape. 

CAUSES. 

The long continued pressure of the child's head upon the 
passages of the mother ; sometimes the use of the forceps cau- 
ses this condition of things. 

RECTO-VAGINAL FISTULA. 

This is an opening into the rectum through the vagina, 
through which the contents of the rectum pass more or less in- 



INFLAMMATION 01 THE WOMB. 14o 

Stead of passing in the usual way, making the patient disgustirg 
to herself, as well as to those with whom she has to do. It is 
however, so frequent an occurrence, nor quite so disgus- 
ting, nor so productive of unpleasant symptoms as . vesico- 
vaginal fistula. 

CAUSES. 

It is usually caused by abscesses of the recto- vaginal sep- 
tum. Accidents with instruments also cause it. 



CHAPTER V. 

INFLAMMATION OF THE WOMB. 

Inflammation of the womb is either acute or chronic. 

ACUTE FORM. 

The substance of the walls of the womb in this case is affec- 
ted. Usually the entire organ is involved, the fundus, body 
and neck. 

SYMPTOMS. 

In some cases the symptoms are mild, so much so, that tha 
patient experiences no particular inconvenience ; in other 
cases they are intense, so affecting the nervous system that 
it is almost overcome, and delirious convulsions, and vomiting 
supervene. After the case is developed there is fever, aching 
in the back, pain in the head and extremities, flushed face, 
furred tongue. If the inflammation be moderate, the patient 
will complain of pain in the sacrum and lumber region, but 
in a severe case, there will be pain in the pelvis, behind the 



144 INFLAMMATION OF THE WOMB. 

pubis, the thighs, abdomen &c. The pain is of a dull aching- 
nature ; hysterical symptoms, convulsions, coma, laughing r 
crying; difficult and painful defacation, nausea and vomiting. 

CAUSES. 

Cold applied during menstruation or after parturition and 
abortions; the feet exposed to the cold, blows, sexual ex- 
cesses, &c. 

CHRONIC FORM. 

The chronic form of uterine inflammation is much more fre- 
quent than it is thought to be. In consequence of that fact, 
it is very much overlooked and neglected. 

SYMPTOMS. 

Pain in the sacrum and lumber region, loins, inability to 
stand or walk to any great extent ; pain in the side and ilium, 
weight and bearing down pain ; leucorrhea, albuminous at 
first, thick, yellow, pain during menstruation, cramping 
pains, and immoderate flow or stoppage of the menstrual, 
discharge, sterility or abortion 

CAUSES. 

The causes of this condition of things are numerous. The 
susceptibility of women to inflammation of the womb as well as 
other forms of uterine disease, is very great, rendered so by 
the circumstances that surround them, as well as their 
unnatural social habits. Excessive sexual intercourse, stimu- 
lating diet, improper clothing, cold during the menstrual 
flow, constipation, standing too long, abdominal supporters, 
over exertion, hemorrhoids, pregnancy, abortion, labor, de- 
composition of clots or portions of the after-birth, with other 
like causes. 



ULCERATION OF THE WOMB. 145 

CHAPTER VI. 

ULCERATION OF THE WOMB. 

Uterine ulceration is found in various forms about the neck 
of that organ resulting generally from inflammation. 

SIMPLE ABRASION. 

A portion of one or both lips of the womb may be affected 
in the removal of the thin covering of the mucous tissue, the 
villi exposed, with their looped capillaries, giving a velvety 
feel to the touch. The mouth and canal of the neck of the 
womb are usually the seat of abrasion, and mostly confined 
to single women. 

SYMPTOMS. 

Leucorrhea, pains in the sacrum and pelvis, irritation of 
the ovaries, indigestion, flatulence, irregular bowels, irreg- 
ular menstruation, and general health affected. 

ULCERATION OF THE LABIA UTERI. 

In the preceeding form of ulceration there is a simple 
removal of the thin covering of the mucous tissue, with an 
exposure of the villi. But in this variety the epithelium is 
not only denuded, but there is a partial destruction of the 
villi with the vascular loops. 

SYMPTOMS. 

These are numerous ; namely, a thick muco-purulent dis- 
charge, headache, menorrbgia, anemia, backache, neuralgia, 

13 



14l) ULCERATION OF THE WOMB. 

bowels irregular, appetite deficient, debility, mental facul 
ties depressed, walking or sitting upright increases paiu, syin- 
pathic irritation of the breasts, rectum and bladder. 

The physician only is able to judge as to the extent of 
these ulcerations, and that after a careful examination. 

RODENT ULCER. 

This form of ulcer rarely occurs under the age of thirty,, 
and it is more apt to take place about the change of life. 
It has been mistaken for epithelial cancer. It is sometimes 
called corroding ulcer. 

SYMPTOMS. 

There is a gradual increase of the ulceration. As it con- 
tinues its work of eating away the affected tissue, the female 
experiences a sense of heat and discomfort in the pelvic re- 
gion, a thin discharge sometimes mixed with blood, debility t 
indigestion, burning pains, attacks of hemorrhage. The phy- 
sician on making an examination, will find an irregularly 
shaped ulcer, with ragged edges, excavated sore, having a 
dry and glassy surface. Sometimes the whole of the neck of 
the womb is destroyed, and the desease continues to eat into, 
the muscular structure of the womb, making destruction as 
it goes. In some cases the patient dies from hemorrhage, ex- 
haustion or peritonitis, before the disease has made inroads r 
to any great extent, into the muscular structure of the organ. 



DISPLACEMENTS OF THE WOMB. 



147 



CHAPTER VII. 
DISPLACEMENTS OF THE WOMB. 

There is quite a variety of displacements of the womb. 
The most common is a simple depression of that organ in the 
-axis of the superior strait. 

Where this condition exists in the unimpregnated, it is us- 
ually complicated with, and is the result of inflammation. The 
round ligaments become relaxed, and as these are the sus- 
taining organs of the womb, it cannot remain in its normal 
position, therefore we have what is commonly called falling 
of the womb. 




A FALLEN WOMB. 



Prolapses of the womb varies from this slight depression 
to a"complete extrusion from the labia. 



148 DISPLACEMENTS OF THE WOMB. 

The patient often experiences great inconvenience while 
suffering from falling of the womb, and she is unfitted to a 
large extent, for the various duties of life. 

RETROVERSION. 

This is where the upper part of the uterus is depressed , by 
being thrown back into the hollow of the sacrum, while the 
neck is drawn forward and upward, so that it is on about a 
level with the arch of the pubis. The difference between re- 
troversion and prolapse of the womb consists in this ; the 
upper part is thrown lower down into the hollow of the sac- 
rum, and the axis of the womb is very nearly natural. 

ANTEVERSION. 

This is an opposite condition to the forgoing. In ante ver- 
sion, the neck of the womb is turned back upon the sacrum, 
and lifted from its natural position,' and the upper part or 
fundus is thrown upon the bladder, and front walls of the 
vagiha, so as to come on a level with the arch of the sym- 
physis pubis. 

CAUSES. 

Increased weight of the womb makes the female susceptible 
to displacement of that organ. Violent exertion, standing 
too long and too much in an erect posture, congestion of 
the womb, straining, jolting, tumors, loaded intestinal canal, 
distended bladder and the like. 

SYMPTOMS. 

Pain, numbness, debility, change in temperature of the 
skin of the lower extremities, sense of heat in the rectum, 



DISPLACEMENTS OF THE WOMB. 149 

cutting, burning pain in the bladder, incontinuence of the 
urine, sense of bearing down, weight and dragging in the 
perineum. 

INVERSION OF THE WOMB. 

By this is meant the turning of the womb inside out, bring- 
ing the fundus or upper part down and the neck up. Inver- 
sion may be partial or complete. In the partial form the 
fundus is depressed in all degrees from a mere indentation 
to a complete protrusion through the neck and mouth of the 
organ. In a complete form the entire organ, body, fundus 
and neck have passed through the mouth of the uterus, and 
hang below it. It may be chronic, or recent in its standing, 
but it almost always takes place either before or at the ex- 
pulsion of the after-birth. 

SYMPTOMS. 

The woman experiences faintness, coldness of the extremi- 
ties, extreme prostration, rapid and feeble pulse, oppression 
about the heart, profuse perspiration, quick breathing, vomi- 
ting, ringing in the ears, blindness. These symptoms hav- 
ing increased in intensity, the patient falls into a deep collapse 
as the result of nervousness. After a while she recovers from 
these symptoms, with the prospect of living for months, 
and regaining an imperfect state of health. 

INVOLUTION OF THE WOMB. 

During pregnancy the womb becomes enlarged, and the 
•contents having been expelled and labor over, the organ 
weighs from one to two pounds. A process of reducing now 
begins which serves to return it to its normal size and weight. 
This is called involution. 



150 DISPLACEMENTS OF THE WOMB. 

Sometimes this process of involution does not begin for ten 
days, or even longer than this, after labor. Contraction one 
after another, interfering with the circulation in the sub- 
stance of the womb, and at the termination of two weeks the 
work is only half finished. Should the contractions be in- 
sufficient, involution is at a stand still, and the womb re- 
mains in its hypertrophied condition. 

CAUSES. 

The most common cause of all the rest that we could name, 
is inflammation. Puerperal inflammation after delivery, atony 
of the muscular fibres of the womb. 

SYMPTOMS. 

Weight, heat, aching in the back, and in some cases great 
danger of flooding. Hemorrhage is almost certain to be pres- 
ent if the case is dependent upon atony of the muscular fibres 
of the womb, especially if there is much exersion on the 
part of the patient. 

Every woman who has informed herself even to a very 
limited extent upon subjects of this kind, can see the impor- 
tance of employing the physician in all cases of labor, as 
so much depends upon proper treatment in all such cases. 
It is reasonable to suppose that the midwives are not 
able to observe the changes, and complications, and rem- 
edy . the accidents that are likely to occur, because not one 
in ten has ever informed herself upon these important sub- 
jects 



CANCER OF THE WOMB. 1M 

CHAPTER VIII. 

CANCER OF THE WOMB. 

Cancer is divided into four varieties, namely, medullary, 
epithelial, colloid, scirrhus. The epithelial and medullary 
are the varieties that most commonly attack the womb. The 
other two varieties are seldom met with in this organ. Of all 
the diseases to which human flesh is subject, there is none 
more destructive and productive of more suffering and dis- 
tress, and more difficult to cure, and more to be dreaded than 
cancer, especially when it occurs in the womb. There are so 
many unpleasant things connected with the disease, and in 
many cases it is so lingering, that the patient becomes a bur- 
den to friends, woried of her life, and wishes a thousand times 
she were dead. 

Although cancer of the womb is sometimes found in differ- 
ent parts of the organ, yet as a general thing the neck is 
the part first attacked, and from this point it gradually ex- 
tends to adjacent tissue, supplanting them, and causing obli- 
teration of the vessels by the intruding deposits. 

In the epithelial form there is an ingraftment upon certain 
points of tissue. The regular tissue is displaced and replaced 
by cancerous deposits, and as a consequence the nutrition of 
the parts is interfered with, on account of the destruction of 
the blood vessels, and sloughing takes place. The parts are 
not removed by the absorbents, but there is sloughing by the 
death of the parts. The smell which is peculiar to this di- 
sease, is caused by the process of sloughing. This process 



152 CANCER OF THE WOMB. 

continues to deepen and widen, in some cases slowly, and 
in others rapidly, destroying the surrounding parts. The de- 
structive process of cancer is much greater in the young than 
in the old. 

SYMPTOMS. 

They are numerous, and many of them very distressing. 
Lancenating, darting, twinging pain, discharge of blood, lim- 
pid serum, smell, these are peculiar to an advanced stage of 
the disease minute sloughs. With a woman who is still men- 
struating the first discharge observed is blood, then the men- 
strual flow increases, then between times the blood is again 
discharged. After the disease has advanced for some time 
hemorrhage becomes a constant occurrence, and is attended 
with fetor which is quite offensive. This discharge emmanates 
from the eroded vessel upon the ulcerated surface. After the 
menstrual period in women who are about to change life, there 
is a limpid, inoffensive serum; soon, this transparent liquid 
becomes gradually colored with blood. It is not very long 
before fetor is observed. Cancerous anemia, straw colored 
appearance of the skin. In the early stages, debility indi- 
gestion, palpitation, restlessness, neuralgia, constipation. In 
the latter stages, night sweats, wandering of mind, unsteadi- 
ness of purpose, delirium, apathy, pain, exhausting dis- 
charges. 

CAUSES. 

The generally accepted opinion is that cancer is hereditary, 
this being the principal and most frequent cause. It is also 
attributable to injuries, chronic ulceration &c. 



TUMOUS Of TIIH WOMB. 153 

CHAPTER IX. 

TUMORS OF THE WOMB. 

Sometimes growths are found within the walls of the womb, 
and these growths have received the name of tumor. Uterine 
tumors are classified as follows : polypus, fibrous, fibro-cellu- 
lar, vascular, encysted. The various forms of tumors are 
distinguished by the position they occupy, and their relation 
to the womb. 

While the fibrous tumor is the most common, it is at the 
same time the most dangerous, and the most difficult to man- 
age, and therefore is much to be dreaded, both by the pa- 
tient and the physician. The fibrous tissues of the womb are 
the source of its emanation, and it remains embedded in the, 
walls of the womb, and as it continues to grow, it causes a 
growth of all the tissues that surround it, thus giving itself 
ample room. 

This variet}^ of tumor usually occupies the posterior or back 
part of the womb, being perfectly organized, and having a 
complete circulation of blood . 

As a consequence of these growths, the functions of the 
womb are interrupted, menstruation arrested or profuse, con- 
tinued an unnatural length of time or recurring too fre- 
quently ; pregnancy is prevented. 

The tumors known as the mucous polypi are much softer 
than the fibrous variety, and originate in and are supported 
by the mucous membrane, and are found on any part of the 



154 OVARIAN TUMORS. 

lining membrane of the cavities, but more commonly in the 
cavity, or the extremity of the neck of the womb. 

A tumor called the cervical tumor is sometimes found sit- 
uated in the submucous substance of the neck. This tumor 
consists of an albuminous fluid. 

It is thought that these tumors are hypertrophied enlarge- 
ments of some particular tissue of the womb. 

SYMPTOMS. 

Menorrhagia and other menstrual irregularities, dull aching 
pain, a sense of weight and bearing down, cramps in one or 
both limbs, difficulty in retaining or passing the urine, con- 
stipation, hemorrhoids, enlargement and tenderness of the 
breasts, attacks of hemorrhage, pains of an expulsive nature, 
debility and loss of flesh in consequence of the frequent attacks 
of hemorrhage. 



CHAPTER X. 
OVARIAN TUMORS. 

By ovarian tumor is to be understood dropsy of the ovaries. 
It is usually the case, that only one ovary is affected at one 
time, frequently, however, the other one manifesting the 



It is the opinion of most writers, that ovarian tumors em- 
anate from and are formed of the hypertrophied tissues of 
the ovaries. When the tumor is small the ovary may be seen 
constituting a large portion of it, and when it has attained a 
larger size the ovary may be lost in its walls. 



OVARIAN TUMORS. 155 

There is a great difference in the shape of ovarian tumors,, 
some are globular, some polyglobular, and others angular. 

The qualities of the contents of these cysts, differ much in 
different cases as well as in different cysts in the same cases. 
While in some cases it may be thin, in others it will be 
thick and tenacious, differing in color, from a black inky to a 
limpid clearness. 

Ovarian dropsy is more common with females advanced in 
age, say above forty, than in younger persons. 

In the origination of ovarian tumors, the condition of the 
ovaries has a great deal to do. It may be that the fibrous 
portion is thickened, condensed, less fragile, less amenable to" 
the influence of the absorbents, and fails to yield to the dis- 
tention of the maturing organs, so that the follicular fluid 
cannot escape, in which case we have the commencement of 
ovarian dropsy. 

There is great significance in the termination of ovarian 
tumors. Sometimes they terminate in complete recovery, 
spontaneous evacuation taking place by the various channels. 
In some cases they increase in size, and pressure is produced 
upon the viscera, frequently bringing about disastrous results. 

SYMPTOMS. 

It is not an easy matter to detect the symptoms, peculiar to 
the early stage of this disease, and not until the abdomen be- 
gins to enlarge, is the patient and the physician made fully 
aware of the existence of the disease. There are some ex- 
ceptional cases, however, in which there may be irritation of 
the rectum and bladder, a sense of weight and oppression, pain 
and numbness down the thigh of the affected side, pain in 



15(3 DISEASES OF WOMEN. 

the back, menstruation generally regular, and perhaps abun- 
dant. 

But take the more advanced stage, and we find great pain 
and tenderness, abdomen distended, menstruation disordered, 
it may be suppressed, strength diminished, constipation, in- 
digestion, frequently passing the water, loss of flesh, some- 
times edema of the thighs and legs. Finally, suffering i& 
very much increased, and the size of the tumor greatly in- 
terrupts the locomotion of the patient Distress is very great, 
nights miserable, edema, and sometimes suppression of the- 
urine, at last fatal prostration. 

CAUSES. 

Excessive and unhealthy menstruation, abortion, prema- 
ture labor, and those things that excite the ovaria and induce 
abortive efforts at the time of ovulation 



CHAPTER XL 

DISEASES OF WOMEN. 

PELVIC CELLUTITIS. 

By this is to be understood inflammation of the cellular 
tissue of the pelvis, the result of abortion, lingering labor,, 
some womb disease, scrofulous diathesis^ 

SYMPTOMS. 

The patient experiences constitutional symptoms, fever,, 
headache, restlessness, local throbbing pain, and aching in 
the limbs, difficulty in passing the urine, nausea and vomi- 



DISEASES OF WOMEN. 157 

ting, tenesmus, the lower part of the abdomen swelled and 
painful. Sometimes the disease goes on until suppuration 
takes place, when under such circumstances the symptoms 
become much more severe, severe rigors occur, intense 
throbbing and tenderness, neuralgic pains down the thighs, 
fluctuation, it may be that pus is discharged in the upper 
part of the vagina, bladder, colon, or rectum. In some ca- 
ses sinuses are formed giving a good deal of trouble, pus 
appearing repeatedly for months. 

PELVIC HAMATOCELE. 

When there is an eifusion of blood into the peritoneal pouch, 
between the womb and rectum, or into the subperitoneal tis- 
sue, behind and around the womb, it is called pelvic ha- 
moteeele. 

SYMPTOMS. 

Where the loss is excessive the patient experiences nervous 
shock, exhaustion, the result of internal hemorrhage, acute 
pain in the lower part of the abdomen, coldness of extremi- 
ties and shivering, vomiting, impaired circulation, the ex- 
pression is repulsive, and death may take place in the space 
of a few hours. In some cases the loss may be very great, 
under which circumstances, there is chilliness followed by 
fever, severe pain in the abdomen, sickness, anxious ex- 
pression of the countenance, the face pinched, often difficulty 
in passing the urine, the rectum irritable. 

NYMPHOMANIA. 

"By nymphomania is meant an inflamed and excited state 
of the generative function. 

14 



158 DISEASES OF WOMEN. 

The seat of this affection is evidently in the brain and 
spinal cord. The great nerve centres being morbidly ex- 
cited, continued erections and spasmodic action are induced. 

CAUSES. • 

Masterbation, exciting diet, indolent, sensual, voluptuous 
way of living, and forced abstinence from sexual enjoyment. 

SYMPTOMS. 

The following are considered the most prominent and can- 
not fail to be very troublesome and unpleasant ; an excessive 
and perpetual desire for sexual intercourse, a mind almost 
constantly engaged in lascivious thoughts, and at the sight of 
every voluptuous immage becomes excited almost to frenzy ; 
a monomania filling the entire soul. During this condition 
of things, the patient makes no discrimination at all, and un- 
der the influence of such an oberration of the mind, atrocious 
crimes have been committed. A woman affected with this- 
disease, will be "observed to make attractive demonstrations. 
A man to her seems like an angel, and with him she invites 
familiarity and contact, her embraces are warm, and her 
kisses are humid with passion. 

If the disease should be further advanced, the symptoms 
as first enumerated, are intensified, and the patient will some- 
times lose all self respect, and is liable to commit grave ex- 
cesses. If a woman once has her nature turned in such a 
direction, her embraces are unending, and it is impossible 
to satisfy her desires. The natural tendency of nymphoma- 
nia is to insanity and death. 



DISEASES OF WOMEN. 159 

HYSTERIA. 

This disease attacks the patient in spells or paroxysms. It 
is undoubtedly a nervous trouble. It is supposed to depend 
upon irritation or congestion of the womb, which irritation 
is reflected to the medulla oblongata, causing a condition 
there and along the cerebro- spinal system, similar to that ex- 
isting in the womb. As of natural consequence, by the irri- 
tated condition of the vital elements of life, every other organ 
is affected, and every other disease is stimulated, so that in 
some cases it is almost impossible to detect the hysterical 
from the genuine. Females from the age of puberty to the 
decline of menstruation, are the most liable to its attacks. 
There is a disease to which the male is subject, which bears 
some resemblance to the disease under consideration, but he 
is not subject to hysteria. 

CAUSES. 

Mental excitement, heated rooms, and sitting constantly 
on cushioned seats, as well as any thing that will produce 
a determination of blood to the womb. Reading novels, and 
romances is very injurious, and has an effect to produce the 
same as the foregoing. 

SYMPTOMS. 

Convulsive movements of the body and limbs, beating the 
breasts with hands clinched, or tearing of hair, or clothes, 
shreaks and screams, violent agitation, a feeling of suffica- 
tion, the attack ending in outbreaks, crying, laughter or 
hiccough. Sometimes the urine is involuntarily discharged 
during the paroxysms, and if the disease has lasted long, soft- 
ening of the spinal cord may occur with paralysis. Hysterical 
paralysis is a common occurrence. 



160 



LEUCORRHEA 



CHAPTER XII. 

LEUCORRHEA. 

By leucorrhea, fluor-albus or whites, we are to understand 
a whitish or colorless discharge from the genitals of the fe- 
male. This discharge varies in hue from a whitish to a yel- 
lowish light-green, or to a slightly red or brown ; inconsis- 
tence, ropy substance ; in quantity, from a slight increase of 
the healthy secretion, to several ounces in twenty-four hours. 
It is the result of an unhealthy condition of the vagina, the 
womb or both It is a very common malady among females, 
comparatively few passing through life without one or more 
attacks of it. 

It is regarded as symptomatic as a general thing, of either 
functional, inflammatory, or organic disease of the female or- 
gans. 

We have two varieties of leucorrhea, the mucous and the 
purulent. 

Of the mucous variety there are two forms, that which is 
peculiar to the neck of the womb, and that which is peculiar 
to the vagina. When leucorrhea proceeds from the neck of 
the womb or its canal, the discharge is a transparent, glary 
fluid, of the consistency of the white of an egg, and it has an 
alkaline reaction, changing a reddened litmus paper to its 
original blue, communicates no stain, but a starchy hardness 
to linen upon which it has been allowed to dry. It has such 
a stringy, ropy, and tenacious consistency, that it is with dif- 
ficulty it is removed from the neck of the womb. If this dis- 



LEUCORRIIEA. 161 

charge emanates simply from the vagina, it is of an opaque 
whitish character and has the consistency of cream, but of aij 
acid reaction, changing blue litmus paper to red, and gives 
a stillness to linen upon which it has fallen and dried, leaving 
a greenish spot, and unlike the former, it is never ropy. 

But taking it for granted that the leucorrheal discharge is 
of a purulent nature, we find it to be of a greenish color, or any 
color between a light yellow and a dark brown, and leaves a 
deep stain on linen,, which is removed by washing. As a 
general thing this discharge proceeds from an excoriated or 
ulcerated surface of some part of the neck of the womb ; some- 
times it comes from the vagina. The acidity or alkalinity 
will decide this point. This form of leucorrhea renders 
women very susceptible to abortion. 

Sometimes this disease assumes such an acrid and irritating 
character, that a disease resembling very much gonorrhea. 
Upon the right distinction between the two depends the hap- 
piness, perhaps of the whole family. The physician, there- 
fore, should be very careful lest he make a mistake and 
thereby bring misery and mortification upon his patient, and 
reproach upon himself. Dr. Donne of Paris says, that, when 
syphilitic matter is examined under a microscope of about 300 
diameters, a multitude of transparent animalcules are seen, 
of a round or oval form, in groups from two to six, and 
and which move in every direction, with a very delicate and 
threadlike appendage ; in leucorrheal matter these are absent. 
But as leucorrhea is frequently the result of secondary syphilis 
in the husband, it is possible that when it originates from this 
cause, animalcules of a simular character may be present, and 
an opinion based upon this microscopical investigation would 
condemn the innocent female to disgrace and wretchedness. 



162 LEUCORRHEA. 



CAUSES. 



The causes of leucorrhea are many. A very common one 
is excessive sexual intercourse. Some men are so sensual and 
animal-like, that they think their wives are only intended to 
gratify their selfish passions, without regard to health or or- 
dinary decency and self-respect. A woman thus situated is 
unfortunate indeed. She is rendered liable not only to present 
disease, but to every malady to which the female sex is sub- 
ject. But there are other causes of this affection, such as the 
lymphatic temperament, scrofulous diathesis, general debility, 
relaxation, an inactive and luxurious life, indolence, stimu- 
lating drinks, high living, with constant sitting on cold 
seats, or on the ground, stimulating injection, excessive . sex- 
ual indulgence, romances, self-abuse, a rapid succession of 
children, prolonged suckling, abortion, congestion of the 
womb and vagina, mechanical injury, abnormal growths, de- 
bility of the womb, excessive menstruation, sudden mental 
or physical shocks. 

SYMPTOMS. 

The discharge is sometimes profuse, and at other times not 
so much so varying according to circumstances in quantity and 
color. In mild cases it is whitish, and in more profuse case3 
it is of a brownish or greenish color. Where the discharge is 
very profuse and of long standing, considerable debility is 
experienced with a sense of pain and weight in the back and 
loins, pain in the stomach, colic, impaired appetite, acid 
stomach, headache, paleness of the countenance, eyes hollow, 
chilliness, palpitation of the heart, mental depression, if not 
remedied, the constitution will become more or less impaired 



CHLOROSIS. 163 

and exhausted, emaciation follows, the flesh becomes loose. 
the pulse small and frequent, the breasts soft, the breath 
fetid, hysterics, swelling of feet and ankles with an incessant 
coldness, derangement of the menstrual flow, it being fre- 
quently diminished or suppressed, obstinate constipation, 
sometimes dropsical swelling of the body. 



CHAPTER XIII. 
CHLOROSIS. 

This disease, like many others, is peculiar to the female. 
It is of veiy common occurrence, especially at the age of puberty. 
Tt is, however, very apt to be associated with a retention of 
the catamenia. It is commonly called green sickness, on ac- 
count of the peculiar greenish appearance of the skin. Young 
unmarried women of delicate lymphatic constitutions are most 
liable to this disease, though it is not strictly confined to this 
class. 

SYMPTOMS. 

The various symptoms of dyspepsia generally present them- 
selves. Also those symptoms peculiar to heart disease and 
abdominal derangements. 

The stomach and bowels are the first to give evidence of 
disordered action. Heaviness, listlessness to motion, fatigue 
on the slightest exertion, palpitation of the heart, pains in 
the back, hips, loins, flatulency, constipation, a morbid appe- 
tite. The patient is melancholy and inclined to be inactive, 
she becomes silent and gloomy, often sighing, and shedding 
tears without cause ; the countenance assumes a pale greenish 



164 CHLOROSIS. 

tint, and the face bloated, the eyes have a languid appearance, 
and the eyelids swell, and have a dark areola around them, 
particularly in the morning, the skin is dry and cool, with 
a flabby feel, the pulse frequent, the breathing quick and 
laborious, digestion deranged, the bowels irregular, dis- 
turbed sleep with unpleasant dreams, the intellect becomes 
dull, and the mind occupied with fanciful notions and projects, 
headache, ringing in the ears, the face cold, neuralgic 
pains, the tongue is usually coated white, sometimes nausea, 
especially in the morning, frequently there is an irritating 
and distressing cough, which may lead her friends to suppo^- 
she has consumption, often various parts of the body will 
manifest dropsical swellings, hysterics and sometimes epi- 
lepsy, leucorrhea or whites, with a retention or suppression of 
the menstrual flow, but should any fluid be discharged at the 
monthly period, it contains an unusual small amount of color- 
ing matter and fiberine. 

While all the above symptoms may not be present in one 
case, yet a great many of them will often be observed, varying, 
of course in character according to circumstances. 

CAUSES. 

The causes of this disorder are various and many. Some 
are of the opinion that it results from a want of power in the 
system, arising from weakness to propel the blood into the 
vessels of the womb, so as to allow the blood to flow from 
them ; but beyond all doubt this weakness has its origin in 
the blood and behind that in the nervous centres. But chlo- 
rosis may be caused by a disordered digestion, living in low, 
damp, and cold habitations which are secluded from the rays 



CHLOROSIS. 165 

of the sun, bad food, late and unseasonable hours, excessive 
use of vinegar, green fruits and all crude articles, warm 
drinks, want of exercise, sedentary and voluptuous living. 
Females of a rapid and premature growth, and those of weak 
and delicate constitutions, scrofulous habit, or nervous tem- 
perament, and those who practice masterbation, who labor 
under great depression of mind, who are affected with some 
menstrual derangement, and who continue for a long time in 
a state of widowhood, are the most susceptible to this disease. 



MISCELLANY. 



THE EFFECTS OF THE SEWING MACH- 
INES ON THE HEALTH AND 
MORALS OF FEMALES. 

That female disease is far more common now, than it was ten 
or fifteen years ago, is very apparent. A woman in perfect 
health is hard to find now, but those who suffer from disease^ 
peculiar to their sex are met with on every hand. Instead of 
two women in every three in the United States, suffering from 
disease, three in every four w T ould be I think, a more correct 
estimate. 

We have, it is true, tight lacing, hot rooms, want of 
out door exercise, with many other things as exciting causes, 
but besides all these, there is one in particular which I de- 
sire to speak of ; namely the Sewing Machine, as indicated 
in the heading of this chapter. 

It is true the Sewing Machine is a great invention, and a 
very useful article, both in the household and in the factory, 
and as such we cannot object it. And at the same time, I am 
of the opinion that it is a potent means of a vast amount of 
harm, and especially with those women who are compelled to 
depend upon its use for a livelihood. 



MISCELLANY. 167 

There is no doubt in my mind, that the constant or pro- 
longed use of the Sewing Machine has the same effect as mas- 
turbation. In fact the rapid action of the foot, with the con- 
sequent motion of the leg and friction of the genitals, I be- 
lieve to be a species of masterbation. 

In self- abuse there is first irritation, then follows engage- 
ment of the womb, leucorrhea, spinal irritation and weak- 
ness. So with the use of the Sewing Machine. The sexual 
excitement produced by the use of the Sewing Machine, in 
a great many cases leads to other immorality, either master- 
bation, or the female becomes the easy, and willing victim 
to the wicked and designing seducer. 

Such a statement may seem to be an exaggeration, yet 
were females to speak what they know to be a fact, the ma- 
jority of them, would say it is a true statement. Parents 
should be made acquainted with such facts, and thereby be en- 
abled to preserve the health, and it may be the virtue of many 
fair young girls who are to be the future mothers of our 
country. 

In confirmation of the foregoing, I will mention the follow- 
ing from a communication of M. Guibout, two or three 
years ago, to the Medical Society of Hospitals, Paris. He 
says : "A month ago two women, entirely unknown to each 
other, and employed in different factories, applied to me for 
advice on the same day. The first was a pale, lymphatic sub- 
ject, with hollow discolored cheeks, much bent and emaciated, 
and suffering from severe epigastric pain, dyspepsia, inces- 
sant leucorrhea, and a marked state of general debility. She 
attributed all her symptoms to the effects of the Sewing Ma- 
chine. Before her admission into the factory, where she was 
in the habit of using it, she was strong, fresh-colored, in vigo- 



168 MISCELLANY. 

rous health, and had never been affected with fluor albus. 
Since seven or eight months, she had observed a gradual decay 
in her health, leucorrhea had set in, growing daily more and 
more copious. "Nor am I," said she, the only sufferer ; 
several other young women in the establishment are similarly 
affected from the same cause. The constant action of the 
lower extremities and the seesaw motion of the entire body, 
wear them out, and cause pains in the back and stomach and 
a leucorrheal discharge." She further stated, that she had 
not noticed in her own case any peculiar sexual excitement, 
but to this she was not liable under any circumstances. It 
was not so with several of her companions, who were often 
compelled to discontinue their labor and to have frequent re- 
course to lotions with cold water. "My second patient was a 
strong, dark-haired woman, of sanguineous temperament. 
She worked a Sewing Machine in a very extensive establish- 
ment, and had enjoyed perfect health up to the period of her 
admission to the factory, where she remained about twelve 
months, being obliged to leave on account of the fatigue and 
pains caused by the nature of her occupation. She also al- 
luded to the excitement of the sexual organs. Five hundred 
women are employed in the house, said she, and two hun- 
dred at least experienced the same effects as myself. The 
workwomen are constantly changing, and are unable to per- 
severe at the trade for any length of time. They enter the 
house in good health, but all leave it thin and debilitated." 
Such cases are common, and I hope the time is not far distant 
when some means will be devised by which the Sewing Machine 
<an be run, especially in the factories, and thereby save our 
females from the ill effects experienced by its constant use v 
at the same time not effect the employment of the women. 



MISCELLANY. 169 



MORAL AND PHYSICAL INFLUENCE OF 

THE MOTHER'S MIND ON THE 

EMBRYO IN UTERO. 

The doctrine, that the child in ntero can be morally and 
physically impressed by the mind of the mother, is generally 
believed, though there are some physicians who discard such 
a theory. There is, however, ample proof in favor of it. 

In view of the belief that the impressions, longings and 
habits of the mother will affect the child, we see the greatest 
defference paid to the tastes, feelings and whims of a pregnant 
woman. 

In a work on infancy by Dr. Combe, published in 1840, 
there is a collection of a large number of illustrations where 
children were mentally and physically "Marked" by "Im- 
pressions" and states of the mother while bearing the child. 
Several French Physicians (among them was Baron Percy, 
a military surgeon and professor) published some years ago 
a number of cases illustrating the fact just enunciated. 

The question of strong mental and emotional impressions 
made upon the mind of the mother during pregnancy, having 
an effect upon the child, has been very often sorrowfully rea- 
lized by many, a fond and anxious mother. 

To illustrate the foregoing, we quote the following case, re- 
ported some time since, by Dr. D. H. Vannuys, of Louis- 
ville, Indiana, r to the Medical Eeportory of Cincinnati. 

He says, I was called to attend Mrs. McN y, in 

confinement, at 8 o'clock, P. M. Dec. 22, 1868, and found 
her in a state of general excitement, and intensely fearful 

15 



170 MISCELLANY. 

of the result of her parturition, although she was the mother 
of five children ; her previous labor having been active, and 
attended with no untoward symptoms. I soon ascertained 
her doubts and fears were based upon her peculiar feeling at 
the time, and unusual feelings during the last two months of 
her gestation. She then gave me the following history of 
her case: On the night of Oct. 12, 1868, she became in- 
tensely frightened in consequence of an intoxicated man, who 
a few days before, demanded of the family in question to va- 
cate the premises owned by him, and being refused, coming 
to the house armed with an axe, commenced manipulations 
upon one corner of the same, and finding but little progress 
made, changed his tactics, and in like manner commenced 
upon the front of the house, at which juncture the husband 

and family rushed to the door. Mrs. McN y, in the 

seventh month of her gestation, imagined she saw the blade? 
of the axe penetrate the skull of her oldest boy, when she 
rushed to his rescue, and it was with much difficulty she 
could be persuaded that no such injury had been inflicted, 
from which time until her confinement she had complained of 
a constant distress, and uneasy sensation in the left hypochon- 
drium, accompanied by an unusual, and almost continual 
motion of the child in utero. In due time a large and well- 
developed male child was born, but upon the left parietal re- 
gion of the scalp, was found a fissure, some three inches in 
length, and in depth, extending from above downwards, 
about five eights of an inch, and about two inches forward of 
the larger fissure was found a much smaller one, very sim- 
ilar in appearance. These fissures seemed to be formed from 
an excess and duplicature of scalp tissue, folded upon itself, 
and bearing no signs of any present or previous inflammatory 



MISCELLANY. 171 

net ion. They corresponded peculiarly in location and appear- 
ance to the wound, the mother imagined she saw inflicted upon . 
her son by the desperado. 

Dr. T. J. Williamson, of Cincinnati, Ohio, contributes 
the following in 1870, to the Richmond and Louisville Medi- 
cal Journal. "Mrs. B , of Virginia, an excellent lady, 

of fine cultivation, the wife of a tradesman, became enceinte ; 
this so enraged the husband, that during her entire term of 
pregnancy, he treated her with great brutality, forced her to 
take emmenagogues with the view of destroying the embryo, 
but all to no purpose, and in due season she gave birth to a 
fine male child. When the boy was old enough to distinguish 
one person from another, he became afraid of his father, and 
nothing could appease his fear. As he grew older his fear 
turned to hatred. The once brutal husband was now a devo- 
ted father, and loved his promising son with great affection, 
but he was at last compelled to send him from home to school, 
from which he never returned during the life-time of his fa- 
ther. For fifteen long years they never saw each other. 
About three years ago the father died, while the son, a noble 
young man, now stands high as a jurist in his native state. 
He deplored his unnatural feeling, and often declared, with 
tears, that he could not tell why it was so." 

"Mr. W , once employed a Miss H -, as teacher 

in his family. Her powers of mind, virtues of heart, and 
charms of persons could not be excelled. Her right inferior 
extremity, however, was three or four inches shorter than 
her left. She had a lustrous brown, and a laughing blue eye. 
Mrs. W , who is one of the kindest, and most affec- 
tionate of women, formed an attachment for Miss H , 

which was, perhaps, as holy as that which bound Damon and 



li'Z MISCELLANY. 

Pythias together. Becoming enceinte, she gave birth to a fe- 
male child, whose right leg, like that of Miss H , was 

three or four inches shorter than her left, and one eye is 
brown, while the other is blue. The girl is now grown, and 

could hardly be distinguished from Miss H , were they 

both of the same age." 

Now if such be the case, should not females be informed 
upon these subjects? If the mother is made aware of the fact, 
that the tastes, passions, whims, inclinations, habits and 
whole future bent of the child is an exponent of her life, 
private and public, during pregnancy, there will be fewer cases 
of malformation, mental or physical. She will take more 
exercise, maintain better self control, be happier, and pass 
through pregnancy and parturition easier. 

Mothers can make their children's mental peculiarities, 
just as they want them, and give them such a shape that they 
will necessarily develope in that direction. 



RULES FOR SCHOOL GIRLS AND 
MISSES. 

1. Love and honor your mother and father, teachers and 
guardians, and pay due respect to every one else. 

*1. Try to cultivate polite and affable manners, and a plea sent 
and agreeable disposition. 

3. Be careful in eating, especially at night. Much Meat- 
is hurtful. Never eat as much as you can, but get up from 
the table feeling as if you could have eaten a little more. 
Be very moderate in eating such things as candies, cakes, &c, 
they are apt to do you much harm. 



MIBCELLANY. 173 

4. Keep your teeth and mouth clean and pure by the use 
of the brush and pure water. 

5. Keep your flesh clean and nice, and your clothing as 
clean and neat as circumstances will permit. A consideration 
of health as well as self respect should prompt you to observe 
this rule. 

(i. If you are attending school, make it a point to know 
your lessons, and if possible to excel, but adopt the plan of 
studying in the morning before breakfast. After the night's 
slumber and rest, you are better prepared to study, your mem- 
ory is more retentive, and you can learn with less labor. 

7. Retire early at night, and rise early in the morning, 
getting up when you first wake. Second naps are said to be 
injurious. 

8. If you are sent on an errand, do not run, unless it be a 
case of real necessity, but walk in a quiet, lady-like manner. 

9. Abstain from jumping, dancing, and lifting things be- 
yond your strength. 

10. Do not lace tightly, but give your form chance to de- 
velops Neither wear your shoes so small that you will suf- 
fer from them. 

11. Do not stand on the damp ground or pavements un- 
necessarily. 

12. Do not stand, sit or walk long in the night air with- 
out having your head covered, and your body properly clad, 
and then not more than is necessary. A great amount of di- 
sease, suffering, and premature death of women is the result 
of the imprudence, carelessness and fashion of girl-hood days, 

l:>. Do not stand on the street or elsewhere, or otherwise 
be too sociable with the youths and others of the opposite sex. 
While it is your duty on all occasions to manifest ordinary 



174 .MISCELLANY. 

politeness and respect, yet you should not go beyond that, 
if unavoidably thrown into their society, be modest, unassum- 
ing, and retiring. 

14. Having been informed by your mother or some other 
female friend, that about the age of thirteen or fourteen, 
sooner or later a change takes place in your system ; that 
this change consists in a discharge of blood from the private 
parts ; that it is usually preceded by pain in the back, head- 
ache, dizziness, drowsiness, &c, that about every twenty 
ei^ht days, or once in every month, in healthy females, this 
discharge conies on ; that it is known as the courses, menses, 
menstruation, catamenia ; that the appearance of this flow 
at puberty, is an evidence that you are susceptible to fecunda- 
tion, or that you are capable of bearing children, you should 
regard it as very important and sacred. Upon the proper per- 
formance of this function depends, to a large extent, your 
health and sometimes it may be, your reputation. 

15, Carelessness and neglect render this function liable to 
many derangements, and those derangements may give a 
Treat deal of distress and trouble, and in some cases end fa- 
tally. Therefore you should be careful not to expose yourself 
more than is necessary, and particularly you should not 
bathe yourself in cold water, while this discharge is upon 
you, or just before it makes its appearance. 

1(5. During the continuance of the menstrual flow, which is 
from three to seven days, you should properly bandage your- 
self, to prevent it from soiling your linen, or trickling down 
upon your feet. 

17. No girl should think of getting married under the age ' 
of eighteen or twenty, as marriages before this age are us- 



MISCELLANY. L70 

uallv attended with a great deal of unhappiness, disease and 

suffering in after life. 



RULES FOR YOUNG LADIES. 

1. Do not keep company regularly, or with the view of 
marrying, until you are eighteen or seventeen at the very 
youngest age. 

-. Before you marry, learn to keep house, and to do 
many other things of a domestic nature, which naturally de- 
volve upon a wife and mother. It is well to know how such 
things should be done, even if your circumstances should jus- 
tify your having others to do them. 

3. Learn to control your temper and cultivate a kind and 
agreeable disposition, for these are frequently conducive to 
health. 

4. Receive the addresses of but one gentleman at a time. 

5. While your courtship should not be unreasonably pro- 
tracted, yet be careful that marriage does not take place too 
soon after acquaintance. Hasty marriages have often given 
rise to a vast amount of unhappiness and distress, to say noth- 
ing about the disease that may follow. 

6. See that your companion's age is suitable to your own, 
likewise that his disposition is not incompatible with yours. 

7. It is very imprudent to sit in a dark room with a gentle- 
man, no matter how well you may know him. 

8 Allow no improper language, or improper advances on 
the part of your company, and be very careful yourself in 
word and act. One imprudent word may give place to others. 
One act seemingly small in itself, may lead to others! of a 
serious and dangerous nature. 



\ 



170 MISCELLANY. 

9. Do not continue the attentions of a young man who desires 
on all occasions to be alone with you. It is proper that your 
parents or guardians should, on some occasion at least, be in 
his presence, and he who objects to it, is not to be trusted. 

10. You should not enter into marriage with a person who 
is sickly and frail, and whom you know to have an affection 
which is liable to render his, as well as your life, unhappy and 
miserable. 

11. Abstain from tight lacing. Woman by fashion and ar- 
tificial appliances has entailed upon herself deformity and di- 
sease, when the Great Creator designed her to remain as he 
created her, perfect, beautiful and healthy. 

12. Have a regular hour for retiring at night, and for ri- 
sing in the morning. Upon regular and sound sleep depends, 
to some extent at least, the health of body and mind. 

lo. Take plenty of exercise, both mental and physical. 
Disease and distress are often the result of inactivity and indo- 
lence. It makes no difference what may be your fortune in 
life, in order to be healthy you must take the necessary ex- 
ercise. 



RULES FOR MARRIED WOMEN. 

1. Have a contented mind. Contentment is better than 
riches. A discontented and unhappy mind, will make you sick, 
and if you are sick, it will prevent you from getting well. 

2. Do not be unnecessarily jealous, for jealousy is very 
hurtful. It has caused many women, as well as many men^to 
lose their minds. And then the cause of jealousy in a great 
many cases is only imaginary. 



MISCELLANY. 177 

3. Strivj to govern your temper, also your sexual passions, 
and be tempo rate in all things. 

4. Protect your feet from the cold and damp at all times, 
but especially during the flow of the menses. 

5. If the catamenia has not come on at the expected time, 
and you have good reason to know it is on account of cold 
or any such ^ause, drink warm teas, and take a foot or hip 
bath. If this fail, apply to the physician. 

6. If you have reason to suppose you are pregnant, abstain 
from the use of drugs, and do no violence to nature in any 
other way, nor suffer it to be done. In this age of fashion, 
women are destroying their health and bringing themselves to 
premature graves, besides purchasing to their souls the con- 
demnation of the Almighty by abortion and the destruction of 
their offspring. 

7. Tight lacing is injurous at any time, but during the 
state of pregnancy, it should not, by any means be practiced. 
The enlargement of the abdomen under such circumstances is 
a perfectly natural process, and is expected in married life, 
and you should not be ashamed of it. 

8: Take moderate exercise during pregnancy as well as at 
any other time. 

9. Keep your bowels regular, by cultivating a habit of 
going to stool every morning. If necessary eat ripe and 
dried fruit, and use mild laxative medicines. 

10. If you have been confined, be sure not to get np too 
soon. Remain in bed at least ten days, living on light diet 
during this time, at the same time guard against becoming 
too weak. 

11. After you are up, do not exert yourself beyond what 
is necessary, and be particularly cautious in lifting. 



178 MISCELLANY. 

12. Be very careful not to take cold in your breasts, or in 
any way injure them, or they may give you a great deal of 
trouble and suffering. 

13. Do not nurse your children too long. This depends 
greatly, however, upon your own condition of health as well as 
that of the child. A woman whose health is delicate, is com- 
pelled to wean her child much sooner than one who is robust 
and strong. On the other hand, a delicate child has to be 
nursed longer than one that is hardy, other things being 
equal. An average of fifteen months, I think, would be a 
good rule to adopt. 

14. Under all circumstances should you be moderate in sex- 
ual indulgence, but especially during pregnancy. 



OR 

EXPLANATION OF WORDS, THAT ARE NOT USED 
IX EVERY DAY CONVERSATION. 



It is necessary in a book like this, to employ many words 
that are not used in every day conversation, words that are 
not understood by the generality of people. 

No matter what we undertake to read, we have greater sa- 
tisfaction if we are able to comprehend the terms used, es- 
pecially the technical ones. In order, therefore, to obviate a 
difficulty which the reader often finds in his way, and which 
might otherwise exist in this book, I have prepared the fol- 
lowing, which I have seen fit to designate a key, feeling con- 
fident that it will be of great utility to all who may peruse this 
volume. 



Abdominal, belonging to the belly* 
Abort, to expel the contents of the womb* 
Abortion, the premature expulsion of the contents' ot the 
womb. 

Accoucheur, one who assists women in child- birth. 
Adherent, united with. 



180 KEY. 

Adhesion, the act of ^sticking together ; being united or at- 
tached. 

Albumen, any substance that partakes of the nature of the 
white of eggs. 

Alimentary, the canal through which the food passes. 

Anastomose, to inosculate; to unite the mouth of one vessel 
with another, as the arteries with the veins. 

Anemia, paleness for want of red globules in the blood; 
bloodless. 

Aneurism, a swelling caused by an enlargement or dilatation 
of an artery. 

Animalcule, an animal whose figure cannot be discerned 
without the aid of the magnifying glass. 

Anterior, before; in front. 

Aorta, the largest artery of the body, which comes directly 
from the heart, and from which all the principal arteries arise. 

Appendages, things added to, as the appendages of the womb ; 
as the fallopian tubes, round ligaments &c. 

Arlyroesc^nt, resembling a tree ; having the figure of a tree. 

Areolar, a colored circle, as seen around the nipple, or around 
the base of a pimple. 

Areolar tissue, cellular tissue; textures composed of cells. 

Ascites, dropsy of the belly. 

Athrophy, wasting ; decrease in size. 

Atrophied, wasted ; decreased. 

Auricle, the upper cavities of the heart ; they receive the 
blood from every part of the body. 

Axis, a real or imaginary straight line passing through the 
centre of a body. 

Calendar, solar month or year, as it appears in almanacs. 

Capillaries, hair-like blood vessels, and nerves of the skin 
and surfaces^of organs. 

Capricious, not constant; not regular : changing about. 
! Cervix, the neck of the womb. 



KIT. 181 

Cerebellum, the hinder part of the head; little brain.. It ia 
thought to have an influence over the generative organs. 
Cervical, belonging to the neck of the womb. 
Cellular, composed of cells. 
Cicatrices' scars ; marks. 

CUtoris, a short body concealed between the anterior extrem- 
ities of the labia. It is thought to bo the principal scat of sex- 
ml pleasure in the female. 
Coagulum, a clot of blood. 

Coccyx, the bone at the extreme lower end of the spinal col- 
umn ; the bone on which we sit. 
C&ition. meeting; copulation. 

Colostrum, a serous fluid generally accompanies the enlarge 
ment of the breasts during gestation, which just after labor and 
for several days afterwards is called colostrum. 

Colloid, colloid cancer consisting ofafiberous structure. 
Commingle, to come together; to unite. 
Commingling, coming together ; uniting. 
Complications, when we have several diseases presented at the 
same time. 

Congenital, existing from birth. 
Congest, to distend with blood. 
Congested, distended vessels, or parts with blood. 
Congestion, distention of vessels, or parts with blood. 
Constipation, costiveness of the bowels. 

Constrictor, a muscle which draws together, and closes an 
orifice of the body. 

Contraction, narrowed, shrunken, 'or drawn condition ; the ef- 
forts of the womb in the expulsion of its contents. 
Copulation, the act of sexual intercourse. 
Corpora Lutea, meaning two corpus luteum. 
Corpus Luteum, after the contents of the Graaffian have been 
discharged at the menstrual periods, the cavity is filled with 
blood, which soon coagulates and is retained in the interior of 

16 



182 KEY. 

the vesicle. The clot contracts and hardens ; the coloring mat- 
ter is somewhat absorbed, and the membrane of the vesicle be- 
comes hypertrophied and convoluted, and to some extent fills 
the cavity. The membrane of the vesicffc continues to enlarge 
for about two weeks, at which time the vesicle has so solidified 
as to receive the name of corpus luteum. 

Corpu scles, minute particles. 

Curvature, a bending in a regular form : crookedness. 

Cutaneous i belonging to the skin. 

Cuticle, the scarf-skin. 

Cylindrical, long circular body of uniform diameter. 

Decidua. a pulpy, semi-fluid substance secreted from the mu- 
cous membrane of the womb, after impregnation has occured. 
Very soon this matter acquires consistence, and has the appear- 
ance of coagulum and lymph. It is supposed that at every 
monthly period a membrane is thrown off with the dischar 
This is called false decidua in contradistinction to the former 
which is called true decidua. 

Decidual, having reference to the decidua. 

Descending, going downward. 

Decaroonizatiojii the act of taking away carbon. 

Depraved, defective ; bad or worse ; as a depraved, defective or 
bad appetite. 

Delirium, disorder and wandering of the intellect ; derange- 
ment of the mind ; bereft of reason. 

Deliquescence , becoming soft and liquid. 

Depression, the act of pressing down ; a sinking or falling. 

Determination, a strong tendency to any given point, or part ; 
as a determination of blood to the head &c. 

Dextrous, ready, expert; skilful. 

Diaphragm, the muscular partition, which separates the lungs 
and cavity of the chest from the bowels and lower belly. 

Diagnosis, the distinction drawn between various diseases by 
symptoms. 



kkv. is:; 

Diameters, measurement* 

Diarrhea, a relaxed state of the bowels: frequent evacuations 
ofloose liquid stools* 

Diathesis, a particular disposition of habit of the constitu- 
tion. 

Dilate, to enlarge ; swell out; to widen in every direction. 

Dilatation, the act of enlarging or swelling. 

Distention, being swollen or stretched, 

Ducts, tubes or canals. 

Dyspnea, oppressed breathing. 

Economy, system, as when we say the female economy, we 
mean the female system. 

Edema, a soft white swelling tilled with fluid, which puts on 
pressure but no pain is felt* 

Edematous, relating to edema. 

Effete, Substances which ^having been used are thrown off 
from the system, as good for nothing. 

Effusion, the pouring out of blood, or other fluid into the 
cavities of the body. 

Epedermis, the outside skin. 

Epegastriui//, the middle region immediately over the small 
end of the stomach. 

Epithelium, a very thin covering upon the mucous tissues, as. 
the lips, throat, bladder, vagina, and the like. 

Epithelial, relating to a very thin covering of the lip#, 
throat &c. 

Elastic, spongy capable of returning at once to its original 
shape, upon the removal of the cause oi its present condition* 

Eminence, elevation. 

Enceinte, pregnant. 

Engorgement, congestion of a part by the accumulation of 
blood in it. 

Excoriated, having the skin pealed off. 

Hhxangineous. destitute of red blood. 



184 KKV. 

Excretory, that which excretes or throws or!' useless mutters 
from the body. 

Extra- Uterine, that condition of the impregnated ovum, 
when it does not reach the womb, but remains imbedded in the 
ovary or fallopian tube, or falls into the general cavity of the 
womb, when the Graafian vesicle bursts,, instead of the ovum 
being grasped by the fimbriated extremities of the fallopian 
tube, and carried into the womb, it is arrested and attaches 
itself to that portion of the mother's body where it may have 
fallen. 

Ext? t at>astion, the act of letting out of its proper vessels or 
ducts : effusion. 

Extremities, the extreme ends; the limbs, as the feet, legs, 
hands and arms. 

Exudations, discharges; being discharged. 
Feces, discharges from the bowels. 

Fecundated, impregnated in consequence of the commingling- 
of the germ cell and sperm cell. 
Fetid, having offensive smell. 
Fetus, the child while yet in the womb. 
Fibrine, one of the principle constituents of the blood. Clot- 
ted blood is formed of fibrine, and the red globules the bloodL 
Fibres, thread like substances ; slender and long filaments. 
Fissure, a cleft ; a narrow opening made by the parting of 
any substance. 
Flatus, wind or gas in the stomach or bowels. 
Flabby, soft; easily bent; hanging loose by its own weight, 
Flaccidity, being flaccid. 
Fluid y a substance that is capable of flowing. 
Follicle, a small bag, sack or fold, from which a fluid is se- 
creted* 

Foramen, an opening or hole. 

Frenzy, a disordered state of the mind ; a species of madness* 

Function, duty ; office ; action. 



KEY. L8S 

Fundus refering to the broad upper part of the womb. 
Fungous, BOit excrescences which grow on ulcers and other 

parts ; proud flesh. 

Galactorrhea! an unusual quantity of milk in nursing mo- 
thers, and which is injurious to the health, in view of the 
weakening effect* 

Ganglion, a small circumscribed tumor; a movable tumor 
found on the tendons. 

Ganglionic, having the nature of ganglion. 

Gangrene, partial death or mortification. 

Gelatinous, jelly-like. 

Glands, soft, roundish bodies. 

Glairy, like or resembling glair. 

Graajfian, vesicles; certain vesicles which are imbedded in 
the substance 01 the ovaries, and which are the ovisaes, con- 
taining the ova. These vesicles are round and transparent 
and begin to develope in infancy and continue without inter 
ruption to the end of the fruitful period. 

trranulations. the filling up of a wound or ulcer by small, 
conical, red, fleshy formations. 

Gonorrhea, an inflammation of the mucous membrane lining 
the canal of the urethra in the male, and of the mucous mem- 
brane of the vulva in the female. It is characterized bv an 
infectious discharge. 

Heartburn, usually applied to a pain in the stomach, which 
is a prominent symptom of dyspepsia. 

Hemorrhoids, piles. 

Humid, moist: damp: wet or watery. 

Hypertrophy, an unhealthy enlargement of an organ without 
change in structure. 

Hypertrophied, enlarged ; swollen. 

Hypothesis, a mere supposition : something not substantiated 
but assumed for the purpose of argument. 

Hypothetical! y, byway of supposition. 



186 KKY 

Hysteria, a paroxysmal, nervous affection peculiar to womlft. 
Imperforate, having no opening or enterance. 
Im perforation, the state of not being perforated. 
Impervious, not to be penetrated or passed through. 
Impregnation, fecundation ; rendering fruitful. 
Impressionable, capable of being impressed. 
Incipient, beginning; outset. 

Incoherent, rambling in speech and ideas ; not adhering. 
Induration, unnatural hardness of parts. 

Inertia, inactivity ; cessation of the contractions of the womk 
Inferior, below. 

Infiltration, the process of entering the pores or cavities of 
the body. 

Inlet, a passage or opening. 

Illusions, desceptive appearances. 

Innovation, change made by the introduction of something 

new. 

Interspace, a space between other things. 

interstitial, refering to or containing interstices. 

Intro-uterine, within the womb. 

Ischia, the hip bone. 

Ischeal, belonging to, or contributed by the ischia. 

labia Majora, the longitudinal folds extending from the 
mons veneris to the perineum, and enclosing the urino-sexuai 

opening. 

Labia, Minora, two small folds of mucous membrane within 
the labia majora, extending from the clitoris downward and 
outward. 

laceration, the act oi tearing ; a rent. 
- Lactation, the act of suckling : the time during which the in- 
fant is suckled. 

Lascivious, loose; lustful. 

Leucorrhea l the whites, common among females. 

Ligament, an elastic, tendinous cord. 



K8Y. 1ST 

Lochia j a bloody discharge from the womb after child-birth, 
Longitudinal, pertaining to length ; running lengthways. 

Lubricate, to make smooth or slippery. 

Lumber Region, the lower part of the back or spinal column. 

Lunar, pertaining to the moon: measured by the revolution 
of the moon. 

Lymph, a thin whitish fluid. 

Malformation, improperly and unnaturally formed. 

Mamma, the female breasts. 

Mammalia, animals that suckle their young. 

Masterbation, polluting one's-self with the hand. 

Ma-stodynia, neuralgia of the breasts. 

Maturation, having ripened ; ready to discharge. 

Medullary, consisting of marrow. 

Medullary Cancer, a soft brain — like elastic tumor. 

Medulla Oblongata, a portion of the brain, and only portion 
indispensable to fetal life and growth. 

Menorrhagia, profuse hemorrhage; immoderate flow of tm? 
menses. 

Menstruation, monthly sickness ; the courses. 

Metritis, acute inflammation of the substance of the unim- 
pregnated womb. 

Miliary, resembling millet seeds. 

Mom veneris, triangular cusheon-like prominence at the lowei 
part of the abdomen in front of the symphysis pubis, and at 
puberty covered with hair. 

Morbid, unhealthy. 

Multifarious, variety; multiplicity; a multifarious woman, or 
a woman who has given birth to children. 

Muscular, partaining to a muscle. 

Nausea, a disposition to vomit. 

Neuralgia, a pain in or disease of the nerves. 

Narcotics, medicines which depress nervous action by theii 
influence upon the brain and spinal narrow. 



[88 ki;\. 

Nymphomania, a morbid and uncontrollable desire for coition, 

a disease peculiar to females. 
Obliterated, erased. 
Orifice, a hole; an opening. 
Ossified, changed to bone. 

Ossification, "the formation of bone. 

Cte J7ter/, the mouth of the womb. 

Ovaries, the organs in the human female in which the eggs 
are formed; the egg bag. 

Ooarites, inflammation of the over ies. 

Ovarium, an ovary. 

Ovisac, vesicle containing an ova. 

Oviform, egg- like in form and figure. 

Ovule, ovum; an egg. 

Ovulum, a future ovum. 

Ovum, an ova; an egg. 

Oxygen, one of the constituents of the air. 

Oxygenisation, the change which the blood undergoes in the 
lungs, under exposure to the action of the oxygen of the atmos- 
phere. 

Palpation, the act of feeling. 

Paralysis, palsy; a total or partial loss of sensibility or mo- 
ion or both, in one or more parts of the body. 

Parieties, sides of an organ. 

Parietal, refering to the parieties or sides of an organ. 

Parturient, bringing forth ; giving birth* 

Parturition, the act bringing labor 

Pathology, that part of medicine that treats upon the know- 
edge of disease. 

Patulous, spreading. 

Pelvis, the large bjny cavity, by some called the basin, at the 
.ower part of the body, containing the lower part of the bowels, 
the womb, bladder, vagina and rectum. 

Perineal, partaining to the perineum. 



KEY. IS!* 

Perineum, the space between the anus and the organ of gen- 
eration. 

Periphery, circumference of a circle. 

Peritoneum, the lining of the abdomen, covering most of the 
organs contained in it. 

Peristaltic the involuntary worm-like movement of the 
bowels. 

Permeable, that which may be passed through without rup- 
ture or displacement of its parts. 

Perpendicular, hanging in a right line from any point to- 
wards the centre of gravity. 

Physiologists, those who understand the science of living 
beings. 

Placenta, after-birth, by which communication is formed be- 
tween the mother and child ; it is also the medium through 
which the child receives nutriment. 

Placenta- Previa, plecental presentation, or presentation of 
the after-birth before the child. 

Plethora, fullness of the blood vessels. 

Plethoric, a fullness of the blood vessels, full habit. 

Plexus, a union of vessels, nerves or fibres in the form of a 
net-work. 

Ptyalism, saliation. 

Polarity, the power of taking a certain direction. 

Posterior, behind. 

Premature, before time, as giving birth to a child two or 
three months of the full term. 

Pregnant, to be with child. 

Pregnancy, the state of being with child ; gestation. 

Premonitory, admonition before hand, as the premonitory 
symptorns of labor. 

Preparatorily, making ready ; previously necessary. 

Presumptive, grounded on probable evidence. 

Preternatural, irregular: unusual; extraordinary. 



190 KKY. 

nipara, a woman who lias not born children before. 

Prolapsus uteri } Hilling of the womb. 

Protract, to continue beyond what is natural. 

Puberty, the age at which a female is capable of be 
children. 

Pubis, the parts over the pubic bone; it is usually covered 
with hair. 

Pulpy, resembling pulp ; soft. 

Pulsation, the beating of the heart, or an artery in carrying 
Oxi the circulation of the blood. 

Purpura, a disease arising from a morbid condition of the 
blood, and characterised by spots or patches resembling bn 
they are red. purple, livid, or redish-brown. 

Quicken, to give life. 

Quiekening, the act of giving life ; accelerating. 

Ramify, to shoot into branches. 
Rational, having the faculty; agreeable to reason. 
Rectum, the lower bowel. 
Reflex, directed backward. 

Reflex- Action, going from one organ to another ; there i g 
ten reflex action from a diseased womb to the stomach. 
Rigors, coldness with shivering chills. 
Relax, to slacken ; to abate ; to relieve. 
Relaxation, the act of slackening ; remission or abatement. 
Reproduction, the capability of producing over again. 
Retract, to go back. 
Retracted, gone back. 
Respiration, breathing. 
Respiratory, belonging to respiration. 
Retroflexion, bent outward or backward. 
Retrogression, the act of going backward. 
Rodent, something that is gnawing in its nature. 
Rotundity, roundness. 
Rugous, drawn or contracted into folds or wrinkles. 



191 



. a Bmall pouch or Back. 

>////. a bone, triangular iu shape at the lower part of the 
i bone. Its Bize is about si\- inches long, and four wide 

Saline, consisting of salt. 

Sanguineous, blood. 

Sanguine, red, having the color of blood: abounding with 

►od. 

ScirrhuS) indurated; induration; hardness. 

otum, the bag which contains the testicles. 
Secretions, the matters separated from the blood. 

retion, the separation of various fluids or matters from the 
tod. 

Secrete, to separate or take from the blood. 
Sedentary, not active ; sitting a great deal of the time. 
% men, a fluid secreted by the male testicles. 
Semi- Calm reous, half calcareous. 
Sem i-fi u id, h al f flu id . 
Sensitive, having sense of feeling. 
Sensible, sensation : whatever may be perceived. 
Sequel, that which comes after: the result or termination. 
Serous, watery. 

Sloughing, separating from the sound flesh ; coming off. 
Spectral, resembling a spectre. 

Spermatozoa, certain animalcules contained in the semen of 
the male. 

Spurious, false ; not real. 

Spurious Pregnancy, not genuine pregnancy: false pregnancy. 
Solidified, made solid. 

Sordes, dark deposits covering the teeth, gums and lips, gen- 
lly observed in low fevers. 
Sound, undecayed : perfect ; healthy. 
Sound, to introduce a sound into the womb. 
Stamina, physical force. 



192 KM. 

Stealth, the act of stealing ; thing stolen ; secret act. 

Sterility, barrenness, incapability of reproducing. 

Still-born, born without life. 

Stools, evacuations from the bowels. 

Strumous, disposed to scrofula: scrofulous or strumous habit. 

Subcutaneous, under the skin. 

Superior Strait, the upper part of the pelvis. 

Suppression, stopi)age; an unhealthy retention of a discharge. 

Sympathetic, the action by which an organ is affected or in - 
fluenced by another. 

Syphilitic, belonging to or proceeding from syphilis. 

Symphysis Pubis, a portion of the female pelvis. 

Symptomatic, indicating the existence of something ; charac- 
teristic of a particular disease. 

Syncope, fainting. 

Tissue, the materials of organised parts of the body, as the 
flesh under the skin is the cellular tissue ; the lips are covered 
with mucous membrane or tissue. 

Transmission, the act of sending from one to another ; com- 
municating from one to another. 

Transverse, running across ; passing from side to side. 

Trunk, the body in contradistinction to the limbs. 

Tubercle, a tumor ofslow r growth, generally of a scrofulous 
character. 

Tuberosities, certain rough process which give attachment to 
muscles or ligaments. 

Tumified, tumefaction ; transcent swelling. 

Turgid, swelled ; distended beyond its natural state by some 
unnatural agent. 

Turgescence, the act of swelling or the state of being swelled. 

Ulceration, the process of becoming an ulcer. 
Umbilicus, the navel. 
Umbilical, partaining to the umbilicus. 
Unossifled, not changed to bone. 



KEY. 193 

Urinate, to pass the urine. 

Urethra, the canal through which the urine passes from the 
bladder. 

Uterus, the womb. 

Uterine, pertaining to the uterus. 

Utero-gestation, pregnancy from conception to birth. 

Valve, a membranous partition within the cavity of a vessel 
which is to allow the passage of a fluid, and opens and shuts to 
prevent its regurgitation. 

Varicose, affected with varix ; a morbid dilatation or enlarge- 
ment of a vein. 

Vascular, supplied with vessels. 

Ventricles, cavities in the heart and brain ; the right ven- 
tricle of the heart sends the blood to the lungs ; the left ven- 
tricle sends it to the whole system. 

Verlibra, the bones which form the back-bone or spinal co- 
lumn. 

Vesicles, small blisters or bladders. 

Viable, capable of living. 

Viability, capability of living. 

Villi, fibres. 

Viscidity, ropiness; stickiness. 

Viscera, the contents of the pelvis, abdomen and thorax. 

Voluptuous, given to the enjoyment of luxury and pleasure, 
indulging to excess in sensual pleasures. 

Vulva, orifice of the female genitals. 

Zoosperms, one of the spermatozoa. 



17 



IZLsTIDIEX:. 



PAGE. 

Abortion 76 

Abscess of mamma 127 

Abscess of labia 135 

Acute vaginitis 140 

Accidental hemorrhage. 105 

Adhesion of labia 134 

After-pains 104 

Amenorrhea, , : 19 

Anteversion. 148 

Agalactia 130 

Apoplectic convulsions, 117 
Appendages of womb ... 3 
A rat ion of blood in af- 
ter-birth ... 53 

Asphyxia 123 

Bony circle of brim of 

* pelvis 93 

Cancer of breast 131 

Causes of position of 

Child &c .* 46 

Cause of suffering &c f ... 88 

Cancer of wo mb 157 

Cavity of pelvis . 89 

Cessation of menses &c. 15 

Chorea .... 180 

Chronic vaginitis 140 

Commencement of men- 
ses &c 12 



PAGE. 

Corpus luteum of men- 

struatiom 31 

Corpus luteum of preg- 
nancy....^..... 32 

Development c^^g. new 

being 43 

Development of mucous 

membrane , 41 

Difference between im- 
pregnation and con- 
ception . 33 

Disorders of menstrua- 
tion 18 

Displacement of womb. 147 
Duration of pregnancy, 

&c 61 

Dysmenorrhea 21 

Effects of sewing ma- 
chines, &c 166 

Effect of menstruation 

&c 14 

Embolism 123 

Epileptic convulsions.. 115 
Extra-uterine pregnancy 68 

Fetal circulation 52 

Frequent desire to uri- 
nate .. 97 

Galactorrhea 131 



196 



INDEX. 



PAGE. 

Gangrenous vulvitis 138 

Generation &c 26 

Gestation 34 

Glandular tumors 130 

Griping and diarrhea.. 98 

Heart disease 124 

Hemorrhage 109 

Hemorrhage after deliv- 
ery 109 

Idiopathic epilepsy 116 

Inflammation of breasts 125 
Inflammation of nipple. 126 
Inflammation of lympha- 
tic &c 127 

Inflammation of womb . 143 
Inflammatory or mem- 
braneous dysmenor- 
rhea 23 

Influence of mother upon 

the child, &c 74 

Inversion of the womb. 149 
Involution of the womb. 149 
Key or explanation of 

words &c 179 

Laceration of perineum. 137 
Lactation and pregnancy 112 

Lochia 110 

Mammitis 127 

Mammary hypertrophy. 129 

Mammary tumors 129 

Maternal stomatitis 133 

Mastodynia 128 

Mechanical .dysmenor- 
rhea 24 

Mechanism of labor 86 

Menstruation 7 

Menorrhagia 24 

Milk 110 



PAGE. 

Morbid adhesion of after- 
birth 104 

Mucous cysts 130 

Moral and physical in- 
fluence of mother's 

mind, &c, 169 

Neuralgic dysmenorrhea 22 

Neck of womb. 93 

Ovarian tumors 154 

Painless contractions &c 97 

Parturition, &c 84 

Passages 89 

Pelvic cellutitis .. . 156 

Plane of inferior strait. 90 

Placenta, &c 49 

Prevention of pregnancy 80 

Pruritus pudendi 139 

Puerperal convulsions ... 114 

Puerperal fever 119 

Puerperal metro-perito- 
nitis 121 

Puerperal epilepsy 116 

Purulent vulvitis 138 

Puerperal vaginitis 141 

Quantity of fluid dis- 
charged &c 13 

Quantity and quality of 

milk Ill 

Recto-vaginal fistula.... 142 

"Retained after-birth 103 

Retroversion 148 

Rodent ulcer 146 

Rupture of perineum.... 136 
Rules for school girls 

and misses 172 

Rules for young ladies. . 175 
Rules for married Wo- 
men.,,,,.. 176 



INDEX. 



107 



PAGE. 

Sanguineous Infiltera- 

tion .... 135 

Secondary hemorrhage .. 100 

Show • OS 

Signs of pregnancy 54 

Some facts connected 

with child &c 47 

Some difficulties of con- 
finement* 118 

Sp u r io u a pregn ancy 64 

Stages of labor 94 

Sterility 62 

Superfetation. 66 

Sudden death of Mother 

&c 122 

Symptomatic epilepsy... 117 



PAGE. 

Syncope 135 

Tumors of womb 153 

Ulceration of labia uteri 145 

Ulceration of womb 145 

Unavoidable hemorr- 
hage 107 

Urethral excrescences... 140 

Viability of child 62 

Vicarious menstruation. 21 
Vesico vaginal fistula ... . 142 
What determines the sex 48 
Where does impregna- 
tion take place 29 

Womb and its appenda- 
ges 1 

Wounds 135 



No matter how much care may be taken in publishing a book, it is 
almost impossible to prevent some errors in the first Edition. To the 
close observer there may appear some in this book which were overlook- 
ed until it was too late to correct them. There is one to which I would 
direct attention. "Placenta" is spelt Plecenta, thus using "e' ; instead 
"a.'" In the next Edition, however, all such errors will be corrected, and 
judging from the manner in which the present Edition is being taken, it 
will be but a short time before the second will be published. 



CERTIFICATES. 



Baltimore, Md., Dec. 81, 1874. 

My personal friend Dr. G. TV. Simpson, has shown me advance 
sheets of a book of which he is author, entitled "Female In- 
structor and Guide to Health." As the title indicates, this is a 
book for general circulation among the persons for whom it was 
written, who sadly need instruction, on the various subjects of 
which the volume treats. No reason can possibly exist, why 
woman, should not deeply ponder and apply the ancient classic 
aphorism "Know Thyself." But how can she know without in- 
struction. I most sincerely wish every married woman in the 
land could read this volume. It is remarkably free from techni- 
cal terminology, and is written in a style which commends it to 
the plainest understanding, besides which, the morality of the 
volume is unexceptionable throughout. 

DAVID WILSON, M. D. 



Baltimore, Md.. January 22, 1875. 
The book, entitled ''Female Instructor and Guide to Health/' 
is carefully written and commends itself to the public. It fills 
the place the author designed it for. most satisfactorily, and will 
mpart to its readers a vast amount of useful information for 
their special benefit, 

WM. H. CLENDINEN M. D, 



CERTIFICATES. 

February 1, 1375. 
The undersigned having examined the "Female Instructor and 
Guide to Health," by Dr. G. W. Simpson, regards it as a very 
valuable work on the subjects upon which it treats, and one 
which should be in the possession of every female. 

Rev. D. A. SHERMER, Iff. D. 

Office, 12 N. Washington Street, Pastor of Washington Street, 
M. P. Church. 



Baltimore, Jan. 1. 1875. 

It affords me great pleasure to add my mite in praise, of the 
excellent work by Dr. G. W. Simpson, entitled "The Female In- 
structor and Guide to Health." A careful perusal of its pages has 
convinced me, that it is in truth, just what its name indicates an 
Instructor and guide. Its title alone, to say nothing of the great 
popularity and high professional standing of the author, should 
at once commend it to the consideration of every Female, Young 
or Old. Manned and Single, for such a book to them, must prove 
of inestimable value. 

" 2>Iany a useful life might have been spared, and many an 
insidious disease checked in the bud, had such works as the 
above been earlier in existence. The book is one of which the 
author may well feel proud. A hearty welcome and unbounded 
success is predicted for the 'The Female Instructor and Guide to 
•Health. " 

We cordially recommend this volume to the earnest attention 
of every Wife and Mother in the land. 

CHARLES W. H. BURNS, M. D. 



LatjraviktjE, Balto. Co., Md., Feb. 5, 1875. 
Dr. Simpson, Sir : I cordially unite with my friend Dr. Burns 
in viewing your Book "Female Instructor and Guide to Health" 
as a valuable Household Treasure, which should be carefully pe- 
rused by every female in our land. The rules for girls, young 
ladies and married women, coming from the professional source, 
they do, should alone entitle it to the serious consideration of the 
opposite sex, who would be "wise unto salvation." 

D. W. CORNTHWAIT, M. D. 




ml 




